Provider Demographics
NPI:1992336549
Name:HEARTLAND LIFE, LLC
Entity type:Organization
Organization Name:HEARTLAND LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-559-8097
Mailing Address - Street 1:8874 US HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070-9638
Mailing Address - Country:US
Mailing Address - Phone:406-861-9500
Mailing Address - Fax:
Practice Address - Street 1:8874 US HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:MT
Practice Address - Zip Code:59070-9638
Practice Address - Country:US
Practice Address - Phone:406-861-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility