MEDICARE: HEARTLAND BEHAVIORAL HEALTH COLLABORATIVE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1336929728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND BEHAVIORAL HEALTH COLLABORATIVE, LLC

Provider Business Mailing Address
First Line	:	6915 NORTH 118TH CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68142-1625
Country	:	US
Telephone Number	:	402-598-4961
Fax Number	:

Provider Business Practice Location Address
First Line	:	6915 NORTH 118TH CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68142-1625
Country	:	US
Telephone Number	:	402-598-4961
Fax Number	:

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	MS. SHANDA ANN MEEKS
Credential	:
Telephone Number	:	402-968-2564

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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