=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407604184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTLAND RANCH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2024
-----------------------------------------------------
Last Update Date | 05/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 HIGHWAY 9 NE
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56215-1160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-368-0922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 HIGHWAY 9 NE
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56215-1160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-368-0922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JEANNIE WAYNE THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 320-368-0922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------