Provider Demographics
NPI:1619077500
Name:HEARTLAND REHABILITATION SERVICES OF FLORIDA LLC
Entity Type:Organization
Organization Name:HEARTLAND REHABILITATION SERVICES OF FLORIDA LLC
Other - Org Name:H2 HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-699-9395
Mailing Address - Street 1:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11363 SAN JOSE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7957
Practice Address - Country:US
Practice Address - Phone:904-260-6212
Practice Address - Fax:904-260-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL160630527OtherDEPARTMENT OF LABOR
FL3851045OtherCIGNA
FLQC6OtherBCBS
FL8845212-10Medicaid
FL4532295OtherAETNA NON-HMO
FL102701OtherAVMED
FL028492100Medicaid