Provider Demographics
NPI:1952137317
Name:HEARTLAND HAVEN LIFECARE LLC
Entity type:Organization
Organization Name:HEARTLAND HAVEN LIFECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELINE
Authorized Official - Middle Name:NIYONZIMA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-444-7528
Mailing Address - Street 1:304 CORMORANT DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9683
Mailing Address - Country:US
Mailing Address - Phone:515-444-7528
Mailing Address - Fax:
Practice Address - Street 1:304 CORMORANT DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-9683
Practice Address - Country:US
Practice Address - Phone:515-444-7528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes253Z00000XAgenciesIn Home Supportive Care