HEARTLAND ALLIANCE HEALTH NPI 1306279070

NPI Information

  • NPI: 1306279070
  • Provider Name: HEARTLAND ALLIANCE HEALTH
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Former Legal Business Name: HEARTLAND HEALTH OUTREACH, INC.
  • CLIA Number: 14D2065706
  • Address: 932 W WASHINGTON BLVD FL 2
    CHICAGO, IL
    ZIP 60607
  • Phone: (773) 275-2586

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NPI Details

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.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)38369ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11306279070MEDICAIDILLINOIS
22283208OTHERILLINOISBUSINESS LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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