Provider Demographics
NPI:1750415816
Name:HEARTLAND ISL
Entity type:Organization
Organization Name:HEARTLAND ISL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-932-4170
Mailing Address - Street 1:18116 ROCKY TOP RD
Mailing Address - Street 2:
Mailing Address - City:ELK CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:65464-9119
Mailing Address - Country:US
Mailing Address - Phone:417-932-4170
Mailing Address - Fax:
Practice Address - Street 1:18116 ROCKY TOP RD
Practice Address - Street 2:
Practice Address - City:ELK CREEK
Practice Address - State:MO
Practice Address - Zip Code:65464-9119
Practice Address - Country:US
Practice Address - Phone:417-932-4170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities