Healthcare Provider Details

I. General information

NPI: 1740514454
Provider Name (Legal Business Name): HEARTLAND CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N TURNER ST
HOBBS NM
88240-3833
US

IV. Provider business mailing address

1604 W 18TH ST
PORTALES NM
88130-7097
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-3156
  • Fax: 575-393-9194
Mailing address:
  • Phone: 575-359-4726
  • Fax: 575-359-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPENDING
License Number StateNM

VIII. Authorized Official

Name: MRS. RANELLE TWEEDY
Title or Position: PRESIDENT
Credential: NHA
Phone: 575-357-4726