| Heritage At Eisenhower High School | |
|
1200 S 16th St Decatur IL 62521-3801 | |
| (217) 362-6262 | |
| (217) 362-6290 |
| Full Name | Heritage At Eisenhower High School |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1200 S 16th St, Decatur, Illinois |
| Authorized Official Name and Position | Candace Clevenger (PRESIDENT/CEO) |
| Authorized Official Contact | 2173626262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage At Eisenhower High School 151 N Main St Decatur IL 62523-1206 Ph: (217) 362-6262 | Heritage At Eisenhower High School 1200 S 16th St Decatur IL 62521-3801 Ph: (217) 362-6262 |
| NPI Number | 1154872026 |
|---|---|
| Provider Enumeration Date | 10/17/2016 |
| Last Update Date | 10/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154872026 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 04070 (Illinois) | Primary |
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