Provider Demographics
NPI:1104960178
Name:HEARTLAND HOME CARE AGENCY INC.
Entity type:Organization
Organization Name:HEARTLAND HOME CARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-654-1362
Mailing Address - Street 1:615 N HOWARD ST
Mailing Address - Street 2:P O BOX 494
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-1407
Mailing Address - Country:US
Mailing Address - Phone:910-654-1362
Mailing Address - Fax:910-654-4363
Practice Address - Street 1:615 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-1407
Practice Address - Country:US
Practice Address - Phone:910-654-1362
Practice Address - Fax:910-654-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 1562251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600509Medicaid