| Heartland Behavioral Health Sc | |
|
3116 N Dries Lane Ste 201 Peoria IL 61604-1295 | |
| (309) 686-1147 | |
| (309) 686-1185 |
| Full Name | Heartland Behavioral Health Sc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3116 N Dries Lane, Peoria, Illinois |
| Authorized Official Name and Position | Andrew Jon Heritch (PRESIDENT) |
| Authorized Official Contact | 3096861147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heartland Behavioral Health Sc 3116 N Dries Lane Ste 201 Peoria IL 61604-1295 Ph: (309) 686-1147 | Heartland Behavioral Health Sc 3116 N Dries Lane Ste 201 Peoria IL 61604-1295 Ph: (309) 686-1147 |
| NPI Number | 1225120421 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9234163759 |
|---|---|
| Medicare Enrollment ID | O20050923000815 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225120421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Andrew J Heritch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407948607 PECOS PAC ID: 1355248550 Enrollment ID: I20031216000635 |
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