Provider Demographics
NPI:1558071134
Name:HEARTLAND RESIDENTIAL CARE FACILITY, INC.
Entity Type:Organization
Organization Name:HEARTLAND RESIDENTIAL CARE FACILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAITKOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-676-1506
Mailing Address - Street 1:1606 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2216
Mailing Address - Country:US
Mailing Address - Phone:816-390-8941
Mailing Address - Fax:816-279-7728
Practice Address - Street 1:1606 S 38TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2216
Practice Address - Country:US
Practice Address - Phone:816-390-8941
Practice Address - Fax:816-279-7728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND III RESIDENTIAL CARE FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00587818Medicaid
MO22268115Medicaid
MO65069904Medicaid