Healthcare Provider Details

I. General information

NPI: 1598646184
Provider Name (Legal Business Name): CHADDOCK ATTACHMENT AND TRAUMA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 24TH ST
QUINCY IL
62301-4492
US

IV. Provider business mailing address

205 S 24TH ST
QUINCY IL
62301-4492
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN PATTON
Title or Position: CHEIF FINANCIAL OFFICER
Credential:
Phone: 217-592-0317