NPIMap

Organization Active NPI

Heritage Behavioral Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Decatur, IL
National Provider Identifier
1295575330
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
HERITAGE BEHAVIORAL HEALTH CENTER, INC.
Practice address
2965 N Main St Ste E
Decatur, IL 62526-4392
Phone
(217) 362-6262
Fax
(217) 362-6290
NPI assigned
May 28, 2024
Organization subpart
Yes
Parent organization
HERITAGE BEHAVIORAL HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Garrison, LCSW
Title
Ceo
Phone
(217) 362-6262

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

2965 N Main St Ste E
Decatur, IL 62526-4392

Mailing address

151 N Main St
Decatur, IL 62523-1206
Phone (217) 362-6262

Other practice location 1

2965 N Main St Ste B
Decatur, IL 62526-6517
Phone (217) 362-6262

Other practice location 2

2965 N Main St Ste C
Decatur, IL 62526-6518
Phone (217) 362-6262

Other practice location 3

2965 N Main St Ste D
Decatur, IL 62526-6519
Phone (217) 362-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050418000456 IL Part B Supplier - Clinic/Group Practice 0547208951 Receives reassigned benefits from 39 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, IL; Decatur, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Heritage Behavioral Health14 organizations share this tax ID, including this one
Part of
Heritage Behavioral Health

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

140 Sunrise Ct
Clinton, IL 61727
Phone (217) 570-0900

2965 N Main St
Ste B
Decatur, IL 62526

2965 N Main St
Ste C
Decatur, IL 62526

2965 N Main St
Ste Be
Decatur, IL 62526

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1295575330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625231206",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 N MAIN ST STE E",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264392",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2965 N Main St Ste B",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625266517",
            "country_code": "US",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2965 N Main St Ste C",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625266518",
            "country_code": "US",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2965 N Main St Ste D",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625266519",
            "country_code": "US",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HERITAGE BEHAVIORAL HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE BEHAVIORAL HEALTH CENTER, INC.",
        "enumeration_date": "2024-05-28",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-362-6262",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.