Provider Demographics
NPI:1003916198
Name:HEARTLAND REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:HEARTLAND REGIONAL MEDICAL CENTER
Other - Org Name:MOSAIC LIFE CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP INTEGRATED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-271-7190
Mailing Address - Street 1:5506 CORPORATE DR STE 1600
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7765
Mailing Address - Country:US
Mailing Address - Phone:816-271-7593
Mailing Address - Fax:816-271-7191
Practice Address - Street 1:5506 CORPORATE DR STE 1600
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7765
Practice Address - Country:US
Practice Address - Phone:816-271-7593
Practice Address - Fax:816-271-7191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO46-22251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580818201Medicaid
KS5830302801Medicaid
KS5830302801Medicaid