Provider Demographics
NPI:1629007810
Name:HEARTLAND HOME CARE LLC
Entity Type:Organization
Organization Name:HEARTLAND HOME CARE LLC
Other - Org Name:HEARTLAND HOME HEALTH CARE AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5734
Mailing Address - Street 1:333 N SUMMIT ST
Mailing Address - Street 2:ATTN: DEAN SHIPMAN
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2615
Mailing Address - Country:US
Mailing Address - Phone:419-254-7841
Mailing Address - Fax:419-252-6448
Practice Address - Street 1:3417 CONCORD RD
Practice Address - Street 2:SUITE C
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9001
Practice Address - Country:US
Practice Address - Phone:717-840-9750
Practice Address - Fax:717-840-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA761605251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007566150017Medicaid
PA1007566150017Medicaid