Provider Demographics
NPI:1891514659
Name:HEARTLAND LACTATION LLC
Entity type:Organization
Organization Name:HEARTLAND LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIETBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-392-0217
Mailing Address - Street 1:520 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67467-3000
Mailing Address - Country:US
Mailing Address - Phone:785-392-0217
Mailing Address - Fax:
Practice Address - Street 1:215 W 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:KS
Practice Address - Zip Code:67467-2311
Practice Address - Country:US
Practice Address - Phone:785-392-0217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty