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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