Provider Demographics
NPI:1750324448
Name:HEARTLAND HOMECARE SERVICES, INC
Entity Type:Organization
Organization Name:HEARTLAND HOMECARE SERVICES, INC
Other - Org Name:HEARTLAND HOMECARE SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-617-7312
Mailing Address - Street 1:7804 E FUNSTON ST
Mailing Address - Street 2:STE 203
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3107
Mailing Address - Country:US
Mailing Address - Phone:316-821-9646
Mailing Address - Fax:316-821-9617
Practice Address - Street 1:7804 E FUNSTON ST STE 203
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-3107
Practice Address - Country:US
Practice Address - Phone:316-821-9646
Practice Address - Fax:316-821-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KS2-104013336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003955760004Medicaid
PA0018510900001Medicaid
KS100442890AMedicaid
NY02248048Medicaid
NJ0032921Medicaid
OK100246840AMedicaid
KS100442890BMedicaid
WA1045504Medicaid
2026569OtherPK
IL=========001Medicaid
KS100442890AMedicaid