Provider Demographics
NPI:1477983963
Name:HEARTLAND REGISTRY, INC.
Entity Type:Organization
Organization Name:HEARTLAND REGISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:863-675-1231
Mailing Address - Street 1:PO BOX 2737
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-2737
Mailing Address - Country:US
Mailing Address - Phone:863-675-1231
Mailing Address - Fax:863-675-1120
Practice Address - Street 1:238 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-5090
Practice Address - Country:US
Practice Address - Phone:863-675-1231
Practice Address - Fax:863-675-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211229251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care