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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