Basic Information
| Provider Information | |||||||||
| NPI: | 1356336028 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARTLAND HOME CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROMEDICA HOME HEALTH (SYLVANIA) | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192525500 | ||||||||
| FaxNumber: | 8004803780 | ||||||||
| Practice Location | |||||||||
| Address1: | 5855 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912273 | ||||||||
| FaxNumber: | 4198859136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 01/23/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4192525734 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N/A | OH | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 141088 | 01 | MI | TRINITY HEALTH PLANS | OTHER | 141088 | 01 | MI | CARE CHOICES | OTHER | 344492440006 | 01 | OH | MEDICAL MUTUAL OF OHIO | OTHER | 34449244002 | 01 | OH | WORKMANS COMPENSATION | OTHER | 4472500 | 05 | MI | MEDICAID | 0577586 | 05 | OH | MEDICAID | 10013 | 01 | OH | PARAMOUNT HEALTH CARE | OTHER |