| Chestnut Health Systems Inc | |
|
1003 Martin Luther King Dr Bloomington IL 61701-1429 | |
| (309) 827-6026 | |
| (309) 820-3574 |
| Full Name | Chestnut Health Systems Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1003 Martin Luther King Dr, Bloomington, Illinois |
| Authorized Official Name and Position | Megan Marie Taylor (MANAGED CARE SUPERVISOR) |
| Authorized Official Contact | 8889273786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chestnut Health Systems Inc 448 Wylie Dr Normal IL 61761-5405 Ph: (888) 924-3786 | Chestnut Health Systems Inc 1003 Martin Luther King Dr Bloomington IL 61701-1429 Ph: (309) 827-6026 |
| NPI Number | 1114351947 |
|---|---|
| Provider Enumeration Date | 08/28/2013 |
| Last Update Date | 02/25/2021 |
| Certification Date | 02/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114351947 | NPI | - | NPPES |
| 04023 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 04023 (Illinois) | Primary |
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