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 1:1909 TAHOE CIR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2770
Practice Address - Country:US
Practice Address - Phone:616-272-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND CENTER FOR AUTISM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-31
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children