Healthcare Provider Details

I. General information

NPI: 1376543520
Provider Name (Legal Business Name): HEARTLAND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 4TH ST
EFFINGHAM IL
62401-3032
US

IV. Provider business mailing address

1200 N 4TH ST PO BOX 1047
EFFINGHAM IL
62401-3032
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-7179
  • Fax: 217-342-6716
Mailing address:
  • Phone: 217-347-7179
  • Fax: 217-342-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number04068
License Number StateIL

VIII. Authorized Official

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