Provider Demographics
NPI:1447246632
Name:HEARTLAND HOME INFUSIONS, INC
Entity type:Organization
Organization Name:HEARTLAND HOME INFUSIONS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-220-6432
Mailing Address - Street 1:901 MCCLINTOCK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:800-836-1147
Mailing Address - Fax:630-734-4678
Practice Address - Street 1:901 MCCLINTOCK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0844
Practice Address - Country:US
Practice Address - Phone:800-836-1147
Practice Address - Fax:630-734-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL032-*004881OtherCONTROLLED SUBSTANCE
IL032-*004881OtherCONTROLLED SUBSTANCE
ILBH4235708OtherDEA
IL363811539001Medicaid