Healthcare Provider Details

I. General information

NPI: 1992336549
Provider Name (Legal Business Name): HEARTLAND LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8874 US HIGHWAY 212
ROBERTS MT
59070-9638
US

IV. Provider business mailing address

8874 US HIGHWAY 212
ROBERTS MT
59070-9638
US

V. Phone/Fax

Practice location:
  • Phone: 406-861-9500
  • Fax:
Mailing address:
  • Phone: 406-861-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DEANE SHANANDER
Title or Position: OWNER
Credential:
Phone: 323-559-8097