Provider Demographics
NPI:1609938927
Name:HEARTLAND SERVICES
Entity Type:Organization
Organization Name:HEARTLAND SERVICES
Other - Org Name:DOUGLAS COOPERATIVE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-453-3254
Mailing Address - Street 1:1101 WAGNER DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3719
Mailing Address - Country:US
Mailing Address - Phone:865-453-3254
Mailing Address - Fax:865-453-3105
Practice Address - Street 1:1101 WAGNER DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3719
Practice Address - Country:US
Practice Address - Phone:865-453-3254
Practice Address - Fax:865-453-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL 3(20)4M4-115-1143251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00348OtherAGENCY NUMBER