Healthcare Provider Details

I. General information

NPI: 1497317051
Provider Name (Legal Business Name): HEARTLAND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KELLY DR SW
CLAY CITY IL
62824-1155
US

IV. Provider business mailing address

PO BOX 1047
EFFINGHAM IL
62401-1047
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-7179
  • Fax:
Mailing address:
  • Phone: 217-347-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON QUANDT
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 217-347-7179