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Organization

HEARTLAND HEALTH LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CRAIG LYLE POLSFUSS MA, MSW (CEO)
(952) 922-9056
Entity
Organization

Contact information

Practice address
6950 FRANCE AVE S STE 14, EDINA, MN 55435-2016
(952) 922-9056
Mailing address
15552 DYNASTY WAY, APPLE VALLEY, MN 55124-7836
(952) 922-9056

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP0620
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
013848700
MN
Enumeration date
11/30/2008
Last updated
11/30/2008
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