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General NPI Number Information
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NPI Number | 1700244571
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Entity Type | Organization
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Legal Business Name | CHESTNUT HEALTH SYSTEMS
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 212 PEARL ST
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City | KAPPA
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State | IL
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Zip | 61738-1855
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Country | US
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Telephone | 309-261-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 212 PEARL ST
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City | KAPPA
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State | IL
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Zip | 61738-1855
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF YOUTH SERVICES
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Name | MYCHELE KENNEY
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Credential |
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Telephone | 309-827-6026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 32510
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License Number State | IL
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