Healthcare Provider Details

I. General information

NPI: 1477534261
Provider Name (Legal Business Name): HEARTLAND CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 W 18TH ST
PORTALES NM
88130-7097
US

IV. Provider business mailing address

13185 W GREEN MOUNTAIN DR
LAKEWOOD CO
80228-3512
US

V. Phone/Fax

Practice location:
  • Phone: 505-359-4719
  • Fax: 505-359-4722
Mailing address:
  • Phone: 303-980-0611
  • Fax: 303-986-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5232
License Number StateNM

VIII. Authorized Official

Name: MR. ROBERT SIEBEL
Title or Position: OWNER PRESIDENT
Credential:
Phone: 303-980-0611