Healthcare Provider Details

I. General information

NPI: 1245364447
Provider Name (Legal Business Name): HEARTLAND RESIDENTIAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 FREDERICK AVE
SAINT JOSEPH MO
64506-2948
US

IV. Provider business mailing address

PO BOX 1028
SAINT JOSEPH MO
64502-1028
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-0768
  • Fax: 816-232-2061
Mailing address:
  • Phone: 816-232-0768
  • Fax: 816-232-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LISA J GILBERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-232-0768