Healthcare Provider Details

I. General information

NPI: 1902040736
Provider Name (Legal Business Name): HEARTLAND SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 10TH ST SE
WELLS MN
56097-1814
US

IV. Provider business mailing address

55 10TH ST SE
WELLS MN
56097-1814
US

V. Phone/Fax

Practice location:
  • Phone: 507-553-3115
  • Fax: 507-553-6060
Mailing address:
  • Phone: 507-553-3115
  • Fax: 507-553-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: MR. WILLIAM ERICKSON
Title or Position: PRESIDENT
Credential:
Phone: 507-893-3155