Healthcare Provider Details

I. General information

NPI: 1225120421
Provider Name (Legal Business Name): HEARTLAND BEHAVIORAL HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 N DRIES LANE STE 201
PEORIA IL
61604-1295
US

IV. Provider business mailing address

3116 N DRIES LANE STE 201
PEORIA IL
61604-1295
US

V. Phone/Fax

Practice location:
  • Phone: 309-686-1147
  • Fax: 309-686-1185
Mailing address:
  • Phone: 309-686-1147
  • Fax: 309-686-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW JON HERITCH
Title or Position: PRESIDENT
Credential: MD
Phone: 309-686-1147