Provider Demographics
NPI:1639727639
Name:HEARTLAND FARM SANCTUARY, LLC
Entity Type:Organization
Organization Name:HEARTLAND FARM SANCTUARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYERL
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:608-571-8764
Mailing Address - Street 1:11713 MID TOWN RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9011
Mailing Address - Country:US
Mailing Address - Phone:608-571-8764
Mailing Address - Fax:
Practice Address - Street 1:11713 MID TOWN RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9011
Practice Address - Country:US
Practice Address - Phone:608-571-8764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty