Provider Demographics
NPI:1760437594
Name:HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC
Entity Type:Organization
Organization Name:HEARTLAND REHABILITATION SERVICES OF MICHIGAN, LLC
Other - Org Name:HEARTLAND REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5541
Mailing Address - Street 1:333 N SUMMIT ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2615
Mailing Address - Country:US
Mailing Address - Phone:419-252-5909
Mailing Address - Fax:419-537-0948
Practice Address - Street 1:33887 5 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2601
Practice Address - Country:US
Practice Address - Phone:734-425-5414
Practice Address - Fax:734-425-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4838850Medicaid
MI236670Medicare Oscar/Certification