Basic Information
| Provider Information | |||||||||
| NPI: | 1952044760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND HOSPICE SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10086 | ||||||||
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| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436990086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 493 BLACKWELL RD STE 319 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201862660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403493970 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2022 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4192525734 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEARTLAND HOSPICE SERVICES, LLC | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4910575 | 05 | VA | MEDICAID |