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General NPI Number Information
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NPI Number | 1801069059
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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 | 04/09/2008
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 2148 VADALABENE DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5632
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Country | US
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Telephone | 618-288-3100
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Fax | 618-288-2278
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Provider Business Mailing Address
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Address Line | 1003 MARTIN LUTHER KING DR
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City | BLOOMINGTON
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State | IL
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Zip | 61701-1429
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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 | MANAGED CARE SUPERVISOR
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Name | MEGAN MARIE TAYLOR
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Credential |
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Telephone | 888-924-3786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 0126-0006
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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