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Organization
HEARTLAND ALLIANCE HEALTH
Active
Organization
HEARTLAND ALLIANCE HEALTH
Active
Other names
Heartland Health Outreach, Chicago Health Outreach
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD STELLON (EXECUTIVE DIRECTOR)
(773) 751-4129
Entity
Organization
Contact information
Practice address
1207 W LELAND, CHICAGO, IL 60640-6043
(773) 334-7117
(773) 334-7277
Mailing address
4750 N SHERIDAN RD STE 449, CHICAGO, IL 60640-5078
(773) 751-4129
(773) 751-4175
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
019
IL
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
019
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019
—
IL
Enumeration date
06/20/2008
Last updated
04/27/2020
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