Healthcare Provider Details

I. General information

NPI: 1043364870
Provider Name (Legal Business Name): CHESTER MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/02/2019
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
CHESTER IL
62233-2542
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4571
  • Fax: 618-826-5823
Mailing address:
  • Phone: 618-826-4571
  • Fax: 618-826-5823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number059007736
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELAINE MOY
Title or Position: PHARMACY MANAGER
Credential: PHARM D
Phone: 618-826-4571