Provider Demographics
NPI:1588810725
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:
Authorized Official - Phone:217-347-7179
Mailing Address - Street 1:1200 N 4TH ST
Mailing Address - Street 2:PO BOX 1047
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3032
Mailing Address - Country:US
Mailing Address - Phone:217-347-7179
Mailing Address - Fax:217-342-6716
Practice Address - Street 1:1116 N WENTHE DR
Practice Address - Street 2:UNIT A
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1635
Practice Address - Country:US
Practice Address - Phone:217-347-7179
Practice Address - Fax:217-342-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IL91S064320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILITIN020Medicaid