Organization
CHADDOCK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN PATTON (DIRECTOR OF FINANCE)
(217) 222-0034
Entity
Organization
Contact information
Practice address
2272 CHESTNUT ST, QUINCY, IL 62301-2215
(217) 222-0034
Mailing address
205 S 24TH ST, QUINCY, IL 62301-4446
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
004048-12
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3A00-IPI-019
—
IL
Enumeration date
06/23/2014
Last updated
06/23/2014
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