Healthcare Provider Details

I. General information

NPI: 1639231731
Provider Name (Legal Business Name): HERITAGE BEHAVIORAL HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N MAIN STREET
DECATUR IL
62523
US

IV. Provider business mailing address

PO BOX 710
DECATUR IL
62525
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 NumberT
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberT
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberT
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberT
License Number StateIL
# 5
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: CEO
Credential:
Phone: 217-362-6262