Provider Demographics
NPI:1063937845
Name:HEARTLAND COMMUNITY CHURCH, INC.
Entity type:Organization
Organization Name:HEARTLAND COMMUNITY CHURCH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:863-299-7787
Mailing Address - Street 1:203 AVE A NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4540
Mailing Address - Country:US
Mailing Address - Phone:863-299-7787
Mailing Address - Fax:863-299-7757
Practice Address - Street 1:203 AVE A NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4540
Practice Address - Country:US
Practice Address - Phone:863-299-7787
Practice Address - Fax:863-299-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8924103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty