Provider Demographics
NPI:1740514454
Name:HEARTLAND CARE INC.
Entity type:Organization
Organization Name:HEARTLAND CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TWEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:575-357-4726
Mailing Address - Street 1:1604 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7097
Mailing Address - Country:US
Mailing Address - Phone:575-359-4726
Mailing Address - Fax:575-359-4722
Practice Address - Street 1:1701 N TURNER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3833
Practice Address - Country:US
Practice Address - Phone:575-393-3156
Practice Address - Fax:575-393-9194
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-28
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPENDING314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD325081Medicare Oscar/Certification