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General NPI Number Information
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NPI Number | 1568356277
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Entity Type | Organization
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Legal Business Name | HEARTLAND CENTER FOR AUTISM
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/07/2025
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Provider Practice Location Address
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Address Line | 1909 TAHOE CIR
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City | OKEMOS
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State | MI
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Zip | 48864-2770
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Country | US
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Telephone | 616-272-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 7155 W HIDDEN LK
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City | PERRY
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State | MI
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Zip | 48872-8152
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Country | US
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Telephone | 616-272-6171
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEX FEDOROWYCH
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Credential |
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Telephone | 616-272-6171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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