NPIMap

Organization Active NPI

Heartland Alliance Health

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chicago, IL
National Provider Identifier
1619134111
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
077560001 Issued in IL
Legal business name
HEARTLAND ALLIANCE HEALTH
Practice address
1015 W Lawrence Ave
Chicago, IL 60640-5017
Phone
(773) 751-4129
Fax
(773) 751-4175
NPI assigned
May 21, 2008
Last updated
Nov 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Authorized official

Name
Jimmy Valentin
Title
Director, Revenue Cycle Management
Phone
(773) 751-4129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 077560001 IL Primary

Addresses

Primary practice location

1015 W Lawrence Ave
Chicago, IL 60640-5017

Mailing address

4750 N Sheridan Rd Ste 449
Chicago, IL 60640-5078
Phone (773) 751-4129

Other identifiers 1

IdentifierTypeStateIssuer
022MedicaidIL

Other names 2

  • Heartland Health Outreach Former legal business name
  • Heartland Health Outreach Pathway Other name

National Provider Directory

National Provider Directory
Tax ID family
Chicago Health Outreach14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

4750 N Sheridan Rd
Ste 500
Chicago, IL 60640
Phone (773) 751-4125

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1619134111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4750 N SHERIDAN RD STE 449",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405078",
            "telephone_number": "773-751-4129",
            "fax_number": "773-751-4175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405017",
            "telephone_number": "773-751-4129",
            "fax_number": "773-751-4175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND ALLIANCE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "VALENTIN",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_title_or_position": "DIRECTOR, REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "773-751-4129"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IL",
            "license": "077560001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Outreach",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Heartland Health Outreach Pathway",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.