Provider Demographics
NPI:1972210888
Name:HEARTLAND CENTER FOR AUTISM
Entity type:Organization
Organization Name:HEARTLAND CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDOROWYCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-272-6171
Mailing Address - Street 1:7155 W HIDDEN LK
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-8152
Mailing Address - Country:US
Mailing Address - Phone:616-272-6171
Mailing Address - Fax:
Practice Address - Street 1:1820 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2772
Practice Address - Country:US
Practice Address - Phone:877-992-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility