Healthcare Provider Details

I. General information

NPI: 1972635308
Provider Name (Legal Business Name): HEARTLAND INDEPENDENT LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 HWY 28
OWENSVILLE MO
65066-1677
US

IV. Provider business mailing address

1010 HWY 28
OWENSVILLE MO
65066-1677
US

V. Phone/Fax

Practice location:
  • Phone: 573-437-5100
  • Fax: 573-437-5117
Mailing address:
  • Phone: 573-437-5100
  • Fax: 573-437-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK ALLEN CHAMBERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-437-5100