Provider Demographics
NPI:1275954299
Name:HEARTLAND HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HEARTLAND HEALTH CENTER, INC.
Other - Org Name:HEARTLAND HEALTH CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FORD-WOLFGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:308-382-4297
Mailing Address - Street 1:2116 W FAIDLEY AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4678
Mailing Address - Country:US
Mailing Address - Phone:308-382-4297
Mailing Address - Fax:308-382-4376
Practice Address - Street 1:2116 W FAIDLEY AVE STE 2100
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4678
Practice Address - Country:US
Practice Address - Phone:308-382-4297
Practice Address - Fax:308-382-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
NEHC069261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100263881-00Medicaid
NA2490Medicare PIN