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NPI Code Detail

MEDICARE: CHESTNUT HEALTH SYSTEMS, INC.

MEDICARE: CHESTNUT HEALTH SYSTEMS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)04023IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760602593
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHESTNUT HEALTH SYSTEMS, INC.
Provider Business Mailing Address
First Line : 1003 MARTIN LUTHER KING DR
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61701-1429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12 N 64TH ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62223-3809
Country : US
Telephone Number : 618-397-0900
Fax Number : 618-397-0093
Authorized Official
Title or Position : MANAGED CARE SUPERVISOR
Name : MEGAN MARIE TAYLOR
Credential :
Telephone Number : 888-924-3786
Provider Enumeration Date : 04/26/2007
Last Update Date : 03/16/2023

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Directions to “CHESTNUT HEALTH SYSTEMS, INC. ” Practice Location

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