Healthcare Provider Details

I. General information

NPI: 1922277045
Provider Name (Legal Business Name): HERITAGE BEHAVIORAL HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 E ORCHARD ST
DECATUR IL
62521-1459
US

IV. Provider business mailing address

PO BOX 710
DECATUR IL
62525-0710
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-9714
  • Fax: 217-422-9714
Mailing address:
  • Phone: 217-362-6262
  • Fax: 217-362-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberT
License Number StateIL

VIII. Authorized Official

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