Basic Information
| Provider Information | |||||||||
| NPI: | 1407955586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND REHABILITATION SERVICES OF FLORIDA LLC | ||||||||
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| OtherOrganizationName: | HEARTLAND REHABILITATION SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 KINGSLEY AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320734847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042642156 | ||||||||
| FaxNumber: | 9042648350 | ||||||||
| Practice Location | |||||||||
| Address1: | 2549 PARK ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043882246 | ||||||||
| FaxNumber: | 9043882454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | LAZARUS | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT - REIMBURSEMENTS | ||||||||
| AuthorizedOfficialTelephone: | 4192525541 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 3141467 | 01 | FL | CIGNA | OTHER | 028493900 | 05 | FL | MEDICAID | 102701 | 01 | FL | AVMED | OTHER | 160630502 | 01 | FL | DEPARTMENT OF LABOR | OTHER | 4477946 | 01 | FL | AETNA NON-HMO | OTHER | 8845212-03 | 05 | FL | MEDICAID |