Healthcare Provider Details

I. General information

NPI: 1093594483
Provider Name (Legal Business Name): CHADDOCK ATTACHMENT AND TRAUMA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W BUCHANAN ST
CARTHAGE IL
62321-1249
US

IV. Provider business mailing address

205 S 24TH ST
QUINCY IL
62301-4446
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-0034
  • Fax:
Mailing address:
  • Phone: 217-222-0034
  • Fax: 217-222-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN PATTON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 217-592-0317