HEARTLAND ALLIANCE HEALTH NPI 1962663120

NPI Information

NPI: 1962663120
Provider Name: HEARTLAND ALLIANCE HEALTH

Former Legal Business Name: HEARTLAND HEALTH OUTREACH

Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
1207 W LELAND
CHICAGO, IL
ZIP 60640
Phone: (773) 334-7117
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HEARTLAND ALLIANCE HEALTH is a mental health (including community mental health center) clinic center in Chicago, IL. HEARTLAND ALLIANCE HEALTH NPI is 1962663120. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Heartland Health Outreach.

The provider's business location address is:

1207 W LELAND
CHICAGO, IL
ZIP 60640-043
Phone: (773) 334-7117
Fax: (773) 334-7277

The provider's authorized official is Edward Stellon .
The authorized official title is Executive Director and has the following contact phone number (773) 751-4129.

The enumeration date for this NPI number is 6/20/2008 and was last updated on 4/27/2020.

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
1	103TA0400X	Psychologist	Addiction (Substance Use Disorder)	019	ILLINOIS	No
2	251B00000X	Case Management				No
3	251S00000X	Community/Behavioral Health		019	ILLINOIS	No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

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
1	019	MEDICAID	ILLINOIS

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: 11/14/2023

NPI Synchronization or Removal

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