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Organization
HEARTLAND SUPPORTED LIVING INC.
Active
Organization
HEARTLAND SUPPORTED LIVING INC.
Active
Other names
Heartland Supported Living Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON MCCORMICK (CORPORATE PRESIDENT)
(573) 475-4108
Entity
Organization
Contact information
Practice address
205 N NEW MADRID ST, SIKESTON, MO 63801-4142
(573) 475-4108
(573) 475-4109
Mailing address
223 N MAIN ST # 122, SIKESTON, MO 63801-4211
(573) 475-4108
(573) 475-4109
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320900000X
—
MO
Enumeration date
04/18/2011
Last updated
07/09/2015
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