Organization
ILLINOIS MEDICAID-SUBSTANCE ABUSE MONMOUTH
Active
Organization
ILLINOIS MEDICAID-SUBSTANCE ABUSE MONMOUTH
Active
Parent organization
BRIDGEWAY INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRIDGEWAY INC
Authorized official
MR. BILL A NELSON LCPC (CEO)
(309) 344-4200
Entity
Organization
Contact information
Practice address
301 INDUSTRIAL PARK RD, MONMOUTH, IL 61462-9794
(309) 734-9461
Mailing address
301 INDUSTRIAL PARK RD, MONMOUTH, IL 61462-9794
(309) 734-9461
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
A-0118-0011-A
IL
2084P0800X
Psychiatry Physician
—
IL
2084P0804X
Child & Adolescent Psychiatry Physician
—
IL
261QM2800X
Methadone Clinic
—
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
IL
Other
Enumeration date
08/27/2015
Last updated
08/19/2019
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