Healthcare Provider Details

I. General information

NPI: 1881128965
Provider Name (Legal Business Name): HERITAGE BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SUNRISE CT
CLINTON IL
61727-9906
US

IV. Provider business mailing address

151 N MAIN ST
DECATUR IL
62523-1206
US

V. Phone/Fax

Practice location:
  • Phone: 217-362-6262
  • Fax: 217-362-6290
Mailing address:
  • Phone: 217-362-6262
  • Fax: 217-362-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARY GARRISON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 217-362-6262