Healthcare Provider Details

I. General information

NPI: 1699645390
Provider Name (Legal Business Name): HERITAGE BEHAVIORAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SUNRISE CT
CLINTON IL
61727-9906
US

IV. Provider business mailing address

140 SUNRISE CT
CLINTON IL
61727-9906
US

V. Phone/Fax

Practice location:
  • Phone: 217-570-0900
  • Fax: 217-362-6290
Mailing address:
  • Phone: 217-570-0900
  • Fax: 217-362-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY GARRISON
Title or Position: CEO
Credential: LCSW
Phone: 217-420-4779