MEDICARE: HEARTLAND HUMAN CARE SERVICES I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	17459	IL

General Provider Information

NPI Number	:	1477761344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND HUMAN CARE SERVICES I

Provider Business Mailing Address
First Line	:	4411 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-275-4960
Fax Number	:	773-275-4965

Provider Business Practice Location Address
First Line	:	4411 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-275-4960
Fax Number	:	773-275-4965

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOHN DINAUER
Credential	:	LCSW
Telephone Number	:	773-571-4000

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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