NPI: 1306279070
Provider Name: HEARTLAND ALLIANCE HEALTH
Former Legal Business Name: HEARTLAND HEALTH OUTREACH, INC.
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization
Specialization: Federally Qualified Health Center (FQHC)
CLIA Number: 14D2065706
Address:
932 W WASHINGTON BLVD FL 2
CHICAGO, IL
ZIP 60607
Phone: (773) 275-2586
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HEARTLAND ALLIANCE HEALTH is a federally qualified health center (fqhc) clinic center in Chicago, IL. HEARTLAND ALLIANCE HEALTH NPI is 1306279070. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Heartland Health Outreach, Inc..
The provider's business location address is:
932 W WASHINGTON BLVD FL 2
CHICAGO, IL
ZIP 60607-217
Phone: (773) 275-2586
The provider's authorized official is Edward Stellon .
The authorized official title is Executive Director and has the following contact phone number (312) 405-0802.
The CLIA number assigned to this NPI record is 14D2065706 - federally qualified health center with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 8/16/2013 and was last updated on 10/15/2020.