Organization
CHESTNUT HEALTH SYSTEMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN MARIE TAYLOR (MANAGED CARE SUPERVISOR)
(888) 924-3786
Entity
Organization
Contact information
Practice address
2148 VADALABENE DR, MARYVILLE, IL 62062-5632
(618) 288-3100
(618) 288-2278
Mailing address
1003 MARTIN LUTHER KING DR, BLOOMINGTON, IL 61701-1429
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
0126-0006
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
C/A 0126-0006-A
—
IL
Enumeration date
04/09/2008
Last updated
03/16/2023
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