Provider Demographics
NPI:1902113764
Name:HEARTLAND RECOVERY SERVICES
Entity Type:Organization
Organization Name:HEARTLAND RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:COOPER-SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:218-454-0041
Mailing Address - Street 1:4781 MAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-5011
Mailing Address - Country:US
Mailing Address - Phone:218-454-0041
Mailing Address - Fax:218-825-8536
Practice Address - Street 1:4781 MAPLETON RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-5011
Practice Address - Country:US
Practice Address - Phone:218-454-0041
Practice Address - Fax:218-825-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility