HERITAGE BEHAVIORAL HEALTH CENTER (NPI# 1942657184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942657184 |
| Entity Type | Organization |
| Organization Name | HERITAGE BEHAVIORAL HEALTH CENTER |
| Other Organization Name | HERITAGE AT CROSSING HEALTHCARE |
| Practice Address |
320 E Central Ave Decatur IL 62521-4665 |
| Mailing Address |
151 N Main St Decatur IL 62523-1206 |
| Practice Telephone | 2178779117 |
| Practice Fax Number | 2173626290 |
| Mailing Telephone | 2173626262 |
| Mailing Fax Number | 2173626290 |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-05-18 |
| Authorized Official Name | MRS. CANDACE CLEVENGER (PRESIDENT/CEO) |
| Authorized Official Telephone | 2173626262 |
| Is Organization Subpart | Y |
| Parent Organization Name | HERITAGE BEHAVIORAL HEALTH CENTER, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 04070 | IL | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Heritage at Crossing Healthcare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821540865 | Heritage Behavioral Health Center | Counselor | 1029 N Water St, Decatur, IL 62523-1022 | 2016-10-25 |
| 1699226563 | Heritage Behavioral Health Center | Community/Behavioral Health | 300 E Eldorado St, Decatur, IL 62523-1037 | 2016-10-17 |
| 1144771015 | Heritage Behavioral Health Center | Community/Behavioral Health | 1 Educational Park, Decatur, IL 62526-2548 | 2016-10-17 |
| 1245781129 | Heritage Behavioral Health Center | Community/Behavioral Health | 4735 E Cantrell St, Decatur, IL 62521-8720 | 2016-10-17 |
| 1053862920 | Heritage Behavioral Health Center | Community/Behavioral Health | 300 Meadow Terrace Pl, Decatur, IL 62521-5252 | 2016-10-17 |
| 1528519584 | Heritage Behavioral Health Center | Community/Behavioral Health | 1499 W Grand Ave, Decatur, IL 62522-1410 | 2016-10-14 |
| 1477727808 | Heritage Behavioral Health Center | Community Based Residential Treatment Facility, Mental Illness | 788 E Clay St, Decatur, IL 62521-2613 | 2008-04-16 |
| 1922277045 | Heritage Behavioral Health Center | Community Based Residential Treatment Facility, Mental Illness | 1421 E Orchard St, Decatur, IL 62521-1459 | 2008-02-22 |
| 1508341371 | Heritage Behavioral Health Center | Case Manager/Care Coordinator | 151 N Main St, Decatur, IL 62523-1206 | 2018-09-27 |
| 1235663949 | Heritage Behavioral Health Center | Counselor | 40 Clinton Plz, Hwy 54, Clinton, IL 61727-2100 | 2017-04-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | HERITAGE BEHAVIORAL HEALTH CENTER, INC. | 151 N Main St, Decatur, IL 62523-1206 |
| Street Address |
320 E CENTRAL AVE |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-4665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306450838 | Amy Elizabeth Duncan | Dietitian, Registered | 320 E Central Ave, Decatur, IL 62521-4665 | 2020-09-02 |
| 1851935142 | Samantha Nicole Hendrix | Physician Assistant | 320 E Central Ave, Decatur, IL 62521-4665 | 2019-10-30 |
| 1417590225 | Abby Iocca | Dietitian, Registered | 320 E Central Ave, Decatur, IL 62521-4665 | 2019-10-24 |
| 1205309267 | Ashley M Garner | Nurse Practitioner | 320 E Central Ave, Decatur, IL 62521-4665 | 2019-01-02 |
| 1669948667 | Community Health Improvement Center Dba Crossing Healthcare | Case Management | 320 E Central Ave, Decatur, IL 62521-6252 | 2018-10-17 |
| 1366927741 | Song Kang | General Practice | 320 E Central Ave, Decatur, IL 62521-4665 | 2018-10-01 |
| 1083193858 | Lindsay Green | Nurse Practitioner | 320 E Central Ave, Decatur, IL 62521-4665 | 2018-08-12 |
| 1710496021 | Nakita Dorez Cook | Nurse Practitioner | 320 E Central Ave, Decatur, IL 62521-4665 | 2017-09-29 |
| 1386096170 | Lake of Decatur Inc | Pharmacy | 320 E Central Ave, Decatur, IL 62521-4665 | 2016-07-06 |
| 1437500485 | Dale Colee | Pharmacist | 320 E Central Ave, Decatur, IL 62521-4665 | 2016-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285244293 | Agape Change Family Counseling & Consultation Services LLC | Counselor | 2128 Willamette Way, Decatur, GA 30032-6036 | 2020-08-04 |
| 1366082356 | Morgan Tudor | Counselor | 433 W Pershing Rd, Decatur, IL 62526-3238 | 2020-01-08 |
| 1083171896 | William Dale Cottrell II | Counselor | 315 W Ponce De Leon Ave Ste 1055, Decatur, GA 30030-2412 | 2019-02-28 |
| 1376000679 | Monica Dawn Ross | Counselor | 106 Lee St. Ne, Suite C, Decatur, AL 35601 | 2019-02-23 |
| 1528538048 | Beatrice Irma Richie | Counselor | 117glen Hollow Circle Apartment #4, Decatur, GA 30034-3003 | 2018-11-27 |
| 1912473711 | Kameshia Hawkins | Counselor | 3011 Rainbow Dr Ste B, Decatur, GA 30034-1643 | 2018-10-18 |
| 1467942706 | Marla Singleton | Counselor | 235 E Ponce De Leon Ave Ste 108, Decatur, GA 30030-3412 | 2018-05-11 |
| 1306348321 | Maureen P Nolan | Counselor | 315 W Ponce De Leon Ave Ste 540, Decatur, GA 30030-2448 | 2018-03-06 |
| 1619493806 | Camille Hankins | Counselor | 2545 Lawrenceville Hwy Ste 150, Decatur, GA 30033-3240 | 2017-08-18 |
| 1609390319 | Subrena Ann Glenn | Counselor | 3745 Brookside Pkwy, Decatur, GA 30034-5714 | 2017-08-03 |
| Find all providers in DECATUR | ||||
Please comment or provide details below to improve the information on HERITAGE BEHAVIORAL HEALTH CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.