| Chestnut Health Systems Inc | |
|
1003 Martin Luther King Dr Bloomington IL 61701-1429 | |
| (309) 827-6026 | |
| Not Available |
| Full Name | Chestnut Health Systems Inc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 1003 Martin Luther King Dr, Bloomington, Illinois |
| Authorized Official Name and Position | Melissa Cooper (MANAGED CARE SUPERVISOR) |
| Authorized Official Contact | 3098203535 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chestnut Health Systems Inc 1003 Martin Luther King Dr Bloomington IL 61701-1429 Ph: (309) 827-6026 | Chestnut Health Systems Inc 1003 Martin Luther King Dr Bloomington IL 61701-1429 Ph: (309) 827-6026 |
| NPI Number | 1356596563 |
|---|---|
| Provider Enumeration Date | 12/02/2008 |
| Last Update Date | 01/31/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356596563 | NPI | - | NPPES |
| C/A-0126-0007-A | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A-0126-0002-A (Illinois) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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