Healthcare Provider Details

I. General information

NPI: 1215062112
Provider Name (Legal Business Name): IL DEPT. OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 LEHMEN DR
CHESTER IL
62233-2542
US

IV. Provider business mailing address

1315 LEHMEN DR P.O. BOX 31
CHESTER IL
62233-2542
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4571
  • Fax: 618-826-3229
Mailing address:
  • Phone: 618-826-4571
  • Fax: 618-826-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. MICHELLE ZIMMER
Title or Position: PATIENT RESOURCE UNIT SUPERVISOR
Credential:
Phone: 618-826-4571