Healthcare Provider Details

I. General information

NPI: 1417320508
Provider Name (Legal Business Name): HEARTLAND RECOVERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 LUCAS PKWY
LOWELL IN
46356-2169
US

IV. Provider business mailing address

2068 LUCAS PKWY
LOWELL IN
46356-2169
US

V. Phone/Fax

Practice location:
  • Phone: 219-690-7025
  • Fax:
Mailing address:
  • Phone: 219-241-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAIME ROGERS
Title or Position: DOO/CEO
Credential:
Phone: 219-690-7025