| Chestnut Health Systems, Inc. | |
|
5109 N Illinois St Apt. 101 Fairview Heights IL 62208-3405 | |
| (618) 239-6245 | |
| Not Available |
| Full Name | Chestnut Health Systems, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5109 N Illinois St, Fairview Heights, Illinois |
| Authorized Official Name and Position | Megan Marie Taylor (MANAGED CARE SUPERVISOR) |
| Authorized Official Contact | 8889243786 |
| 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: () - | Chestnut Health Systems, Inc. 5109 N Illinois St Apt. 101 Fairview Heights IL 62208-3405 Ph: (618) 239-6245 |
| NPI Number | 1558649608 |
|---|---|
| Provider Enumeration Date | 07/22/2011 |
| Last Update Date | 03/16/2023 |
| Certification Date | 03/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558649608 | NPI | - | NPPES |
| 04023 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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