Provider Demographics
NPI:1306408943
Name:HEARTLAND HUMAN SERVICES
Entity Type:Organization
Organization Name:HEARTLAND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:QUANDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-347-7179
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1047
Mailing Address - Country:US
Mailing Address - Phone:217-347-7179
Mailing Address - Fax:217-342-6716
Practice Address - Street 1:800 KELLY DR SW
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:IL
Practice Address - Zip Code:62824-1155
Practice Address - Country:US
Practice Address - Phone:217-347-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)