Healthcare Provider Details

I. General information

NPI: 1306834726
Provider Name (Legal Business Name): ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 LEHMEN DR
CHESTER IL
62233-2542
US

IV. Provider business mailing address

PO BOX 31 1315 LEHMEN DR CHESTER MENTAL HEALTH CENTER
CHESTER IL
62233-0031
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 Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. MICHELLE LEIGH ZIMMER
Title or Position: REIMBURSEMENT OFFICE II SUPERVISOR
Credential:
Phone: 618-826-4571