Provider Demographics
NPI:1104925429
Name:HEARTLAND REHABILITATION SERVICES OF FLORIDA LLC
Entity type:Organization
Organization Name:HEARTLAND REHABILITATION SERVICES OF FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:540 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4847
Mailing Address - Country:US
Mailing Address - Phone:904-264-2156
Mailing Address - Fax:904-264-8350
Practice Address - Street 1:15260 NW 147TH DR
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5309
Practice Address - Country:US
Practice Address - Phone:386-462-4349
Practice Address - Fax:386-418-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL028496300Medicaid
FL1617682OtherCIGNA
FL8845212-35Medicaid
FLQ1COtherBCBS
FL160630535OtherDEPARTMENT OF LABOR
FL4477946OtherAETNA NON-HMO
FL102701OtherAVMED