Provider Demographics
NPI:1699941641
Name:HEARTLAND ALTERNATIVE SERVICE PROGRAM
Entity type:Organization
Organization Name:HEARTLAND ALTERNATIVE SERVICE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-686-5488
Mailing Address - Street 1:405 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5807
Mailing Address - Country:US
Mailing Address - Phone:573-686-5488
Mailing Address - Fax:573-686-2752
Practice Address - Street 1:405 POPLAR ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5807
Practice Address - Country:US
Practice Address - Phone:573-686-5488
Practice Address - Fax:573-686-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO188261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder