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General NPI Number Information
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NPI Number | 1003291287
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Entity Type | Organization
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Legal Business Name | HEARTLAND RESOURCE COUNCIL
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 205 N NEW MADRID ST
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City | SIKESTON
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State | MO
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Zip | 63801-4142
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Country | US
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Telephone | 573-475-4108
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Fax |
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Provider Business Mailing Address
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Address Line | 205 N NEW MADRID ST
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City | SIKESTON
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State | MO
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Zip | 63801-4142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RON MCCORMICK JR.
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Credential |
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Telephone | 573-475-4108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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