Organization
HEARTLAND ALLIANCE HEALTH
Active
Parent organization
HEARTLAND HEALTH OUTREACH INC
Other names
Heartland Health Outreach, Inc., Heartland Alliance Health - James West
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEARTLAND HEALTH OUTREACH INC
Authorized official
EDWARD STELLON (EXECUTIVE DIRECTOR)
(312) 405-0802
Entity
Organization
Contact information
Practice address
932 W WASHINGTON BLVD FL 2, CHICAGO, IL 60607-2217
(773) 275-2586
Mailing address
1015 W LAWRENCE AVE, CHICAGO, IL 60640-5017
(773) 751-4129
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
38369
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306279070
—
IL
01
—
2283208
BUSINESS LICENSE
IL
Enumeration date
08/16/2013
Last updated
10/15/2020
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