Provider Demographics
NPI:1417580101
Name:HEARTLAND ALLIANCE HEALTH
Entity Type:Organization
Organization Name:HEARTLAND ALLIANCE HEALTH
Other - Org Name:HEARTLAND ALLIANCE HEALTH - EW SUPR
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-751-4129
Mailing Address - Street 1:4750 N SHERIDAN RD STE 449
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5078
Mailing Address - Country:US
Mailing Address - Phone:773-751-4129
Mailing Address - Fax:773-751-4175
Practice Address - Street 1:5501 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2229
Practice Address - Country:US
Practice Address - Phone:773-632-5700
Practice Address - Fax:773-962-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder