Provider Demographics
NPI:1851343768
Name:HEARTLAND HOSPICE SERVICES LLC
Entity Type:Organization
Organization Name:HEARTLAND HOSPICE SERVICES LLC
Other - Org Name:PROMEDICA HOSPICE (FT. WAYNE)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - REIMBURSEMENTS
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:ATTN: DEAN SHIPMAN
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-254-7841
Mailing Address - Fax:419-252-6448
Practice Address - Street 1:1315 DIRECTORS ROW
Practice Address - Street 2:SUITE 210
Practice Address - City:FT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1284
Practice Address - Country:US
Practice Address - Phone:260-484-7622
Practice Address - Fax:260-484-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07-006341-1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200142900(A)Medicaid
IN200142900DMedicaid
IN151521Medicare Oscar/Certification