Provider Demographics
NPI:1417320508
Name:HEARTLAND RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:HEARTLAND RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-690-7025
Mailing Address - Street 1:2068 LUCAS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-2169
Mailing Address - Country:US
Mailing Address - Phone:219-690-7025
Mailing Address - Fax:
Practice Address - Street 1:2068 LUCAS PKWY
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2169
Practice Address - Country:US
Practice Address - Phone:219-690-7025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder