Heartland Hospice Services LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

413526 Issued in MI

Legal business name

HEARTLAND HOSPICE SERVICES LLC

Practice address

695 Kenmoor Ave SE Ste B
Grand Rapids, MI 49546-2375

Phone

(616) 956-0636

Fax

(616) 956-7617

NPI assigned

May 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Martin D Allen

Title

Director

Phone

(419) 252-5734

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 4

• ProMedica Hospice (Fremont) Doing business as
• ProMedica Hospice (Grand Rapids) Doing business as
• ProMedica Hospice (Kalamazoo) Doing business as
• ProMedica Hospice (Traverse City) Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Odyssey Healthcare Holding Company

  • Community Based Hospice Care Agency
  • Grand Rapids, MI
  • NPI 1114627890

  Sold to, 2023-11-01

  CMS change of ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1699728980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "address_2": "ATTN: DEAN SHIPMAN",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-254-7841",
            "fax_number": "419-252-6448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 KENMOOR AVE SE STE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462375",
            "telephone_number": "616-956-0636",
            "fax_number": "616-956-7617"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8075 Creekside Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490245390",
            "country_code": "US",
            "telephone_number": "269-324-5705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Eastern Sky Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496847351",
            "country_code": "US",
            "telephone_number": "231-935-3089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1053 W Main St",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "MI",
            "postal_code": "494121408",
            "country_code": "US",
            "telephone_number": "616-956-0636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HEARTLAND HOSPICE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MI",
            "license": "413526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1413573",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Hospice (Fremont)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Hospice (Grand Rapids)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Hospice (Kalamazoo)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProMedica Hospice (Traverse City)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Community Based Hospice Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.