Organization
CHESTNUT HEALTH SYSTEMS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA COOPER LPN (MANAGED CARE SUPERVISOR)
(309) 820-3535
Entity
Organization
Contact information
Practice address
1003 MARTIN LUTHER KING DR, BLOOMINGTON, IL 61701-1429
(309) 827-6026
Mailing address
1003 MARTIN LUTHER KING DR, BLOOMINGTON, IL 61701-1429
(309) 827-6026
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
A-0126-0002-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C/A-0126-0007-A
—
IL
Enumeration date
12/02/2008
Last updated
01/31/2019
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