Provider Demographics
NPI:1689661795
Name:HEARTLAND HOME HEALTH CARE
Entity Type:Organization
Organization Name:HEARTLAND HOME HEALTH CARE
Other - Org Name:METHODIST PHARMACY @ ALLEN ROAD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARNEWOLT
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:309-683-8885
Mailing Address - Street 1:2338 W. SUD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61525
Mailing Address - Country:US
Mailing Address - Phone:309-683-8885
Mailing Address - Fax:309-683-8850
Practice Address - Street 1:2338 W SUD PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7482
Practice Address - Country:US
Practice Address - Phone:309-683-8885
Practice Address - Fax:309-683-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-028094333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
024606003Medicare ID - Type Unspecified