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General NPI Number Information
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NPI Number | 1649645573
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Entity Type | Organization
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Legal Business Name | CHAMNESS CARE, INC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 1955 STATE ROUTE 146 E
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City | ANNA
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State | IL
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Zip | 62906-3501
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Country | US
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Telephone | 618-833-4774
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Fax | 618-833-5295
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Provider Business Mailing Address
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Address Line | PO BOX I
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City | JONESBORO
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State | IL
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Zip | 62952-0479
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Country | US
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Telephone | 618-833-4774
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Fax | 618-833-5295
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BEVERLY TWEEDY
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Credential | NHA
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Telephone | 618-833-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 199400197S
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License Number State | IL
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