Provider Demographics
NPI:1750857827
Name:HEART OF AMERICA INDIAN CENTER
Entity type:Organization
Organization Name:HEART OF AMERICA INDIAN CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MORNINGSTAR PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-421-7608
Mailing Address - Street 1:600 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2910
Mailing Address - Country:US
Mailing Address - Phone:816-421-7608
Mailing Address - Fax:816-421-6493
Practice Address - Street 1:600 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2910
Practice Address - Country:US
Practice Address - Phone:816-421-7608
Practice Address - Fax:816-421-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder