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General NPI Number Information
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NPI Number | 1043465321
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Entity Type | Organization
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Legal Business Name | HEARTLAND HEALTH LLC
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Dates
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Enumeration Date | 11/30/2008
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Last Update Date | 11/30/2008
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Provider Practice Location Address
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Address Line | 6950 FRANCE AVE S STE 14
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City | EDINA
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State | MN
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Zip | 55435-2016
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Country | US
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Telephone | 952-922-9056
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Fax |
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Provider Business Mailing Address
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Address Line | 15552 DYNASTY WAY
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7836
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Country | US
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Telephone | 952-922-9056
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CRAIG LYLE POLSFUSS
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Credential | MA, MSW
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Telephone | 952-922-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LP0620
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License Number State | MN
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