Provider Demographics
NPI:1922277045
Name:HERITAGE BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:HERITAGE BEHAVIORAL HEALTH CENTER
Other - Org Name:DECATUR MENTAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-362-6262
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62525-0710
Mailing Address - Country:US
Mailing Address - Phone:217-362-6262
Mailing Address - Fax:217-362-6290
Practice Address - Street 1:111 TIMARI CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5367
Practice Address - Country:US
Practice Address - Phone:217-362-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE BEHAVIORAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
ILT320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)