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General NPI Number Information
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NPI Number | 1033157748
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Entity Type | Organization
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Legal Business Name | CHADDOCK
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 205 S 24TH ST
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City | QUINCY
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State | IL
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Zip | 62301-4446
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Country | US
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Telephone | 217-222-0034
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Fax | 217-222-3865
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Provider Business Mailing Address
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Address Line | 205 S 24TH ST
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City | QUINCY
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State | IL
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Zip | 62301-4446
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Country | US
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Telephone | 217-222-0034
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Fax | 217-222-3865
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | KRISTEN PATTON
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Credential |
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Telephone | 217-592-0317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 308658-03
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 004049-10
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License Number State | IL
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