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General NPI Number Information
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NPI Number | 1174651269
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Entity Type | Organization
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Legal Business Name | HEARTLAND RESIDENTIAL CARE FACILITY
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 117 S 15TH ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64501-2904
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Country | US
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Telephone | 816-676-1505
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Fax |
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Provider Business Mailing Address
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Address Line | 117 S 15TH ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64501-2904
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Country | US
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Telephone | 816-676-1505
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Fax |
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Authorized Official
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Title or Position | ASST. ADMINISTRATOR
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Name | BROOKE ASHLEY WAITKOSS
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Credential |
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Telephone | 816-676-1505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 031795
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License Number State | MO
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