CHESTNUT HEALTH SYSTEMS, INC. (NPI# 1558649608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558649608 |
| Entity Type | Organization |
| Organization Name | CHESTNUT HEALTH SYSTEMS, INC. |
| Practice Address |
5109 N Illinois St Apt. 101 Fairview Heights IL 62208-3405 |
| Mailing Address |
1003 Martin Luther King Dr Bloomington IL 61701-1429 |
| Practice Telephone | 6182396245 |
| Mailing Telephone | 3098276026 |
| Mailing Fax Number | 3098203574 |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2018-10-03 |
| Authorized Official Name | MELISSA LYNN COOPER (MANAGED CARE SUPERVISOR) |
| Authorized Official Telephone | 3098203535 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | 04023 | IL | Agencies |
| N | 251S00000X | Community/Behavioral Health | 04023 | IL | Agencies |
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 04023 | IL | Residential Treatment Facilities |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MENTAL HEALTH LICENSE | 04023 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992179642 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 110 Rottingham Ct, Suite B, Edwardsville, IL 62025-3788 | 2015-11-18 |
| 1770850075 | Chestnut Health Systems, Inc. | Clinic/Center | 648 State St Bldg B, Madison, IL 62060-1420 | 2011-11-30 |
| 1902184054 | Chestnut Health Systems, Inc. | Clinic/Center | 648 State St Bldg A, Madison, IL 62060-1420 | 2011-07-22 |
| 1194021485 | Chestnut Health Systems, Inc. | Case Management | 732 S Illinois St, Belleville, IL 62220-2142 | 2011-02-03 |
| 1346566445 | Chestnut Health Systems, Inc. | Community Based Residential Treatment Facility, Mental Illness | 814 Saint Louis Rd, Apt. 232, Collinsville, IL 62234-2023 | 2010-04-14 |
| 1245781079 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2016-10-17 |
| 1912371824 | Chestnut Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 370 Houbolt Rd, Suite 101, Joliet, IL 60431-8303 | 2015-11-17 |
| 1043587348 | Chestnut Health Systems, Inc. | Case Management | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2011-11-30 |
| 1003194150 | Chestnut Health Systems, Inc. | Clinic/Center | 3924 Oakmont Dr, Pontoon Beach, IL 62040-4395 | 2011-07-22 |
| 1386922433 | Chestnut Health Systems, Inc. | Clinic/Center | 1218 19th St, Granite City, IL 62040-4501 | 2011-07-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | CHESTNUT HEALTH SYSTEMS, INC. | 1003 Martin Luther King Drive, Bloomington, IL 61701 |
| Washington State Corporations | CHESTNUT HEALTH SYSTEMS, INC. | 1003 Martin Luther King Dr, Bloomington, IL 61701 |
| Street Address |
5109 N ILLINOIS ST APT. 101 |
| City | FAIRVIEW HEIGHTS |
| State | IL |
| Zip Code | 62208-3405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063691897 | Southern Illinois Healthcare Foundation, Inc. | Family Medicine | 5109 N Illinois St, Fairview Heights, IL 62208-3405 | 2007-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740829647 | Stephanie Lynn Arzavala-reed | Counselor | 8.5 Canty Lane, Fairview Heights, IL 62208 | 2019-12-26 |
| 1649822156 | Preferred Behavioral Health | Community/Behavioral Health | 141 Market Place Drive, Suite 100, Fairview Heights, IL 62208 | 2019-07-15 |
| 1164929055 | Itic Support Services Inc | Psychiatry & Neurology | 141 Market Pl Ste 100, Fairview Heights, IL 62208 | 2018-04-09 |
| 1023525102 | Karen E. Reinacher | Speech-Language Pathologist | 21 Circle Dr., Fairview Heights, IL 62208 | 2018-01-10 |
| 1316465297 | Rachel Moser | Behavioral Analyst | 9510 St. Clair Ave, Fairview Heights, IL 62208 | 2017-08-31 |
| 1952826471 | Tomika Eiland | Social Worker | 413 David Dr, Fairview Heights, IL 62208 | 2017-08-05 |
| 1194113852 | Rachel Logan | Social Worker | 10850 Lincoln Trail, Suite 16 #3, Fairview Heights, IL 62208 | 2015-01-05 |
| 1255746715 | Center for Advanced Medicine LLC | Internal Medicine | 5036 N Illinois St, Suite 1, Fairview Heights, IL 62208 | 2014-06-24 |
| 1033463393 | Katherine Johnson I | Physical Therapy Assistant | 320 N Ruby Ln, Fairview Heights, IL 62208 | 2012-11-07 |
| 1508118779 | Nicole Kovacic | Physical Therapy Assistant | 5501 Perrin Drive, Fairview Heights, IL 62208 | 2012-10-11 |
| Find all providers in zip 62208 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1881291789 | Jessica Weisbach, LLC | Clinic/Center | 2257 N Kedzie Blvd Apt 3, Chicago, IL 60647-2561 | 2020-10-04 |
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| 1144827320 | Envision Unlimited | Clinic/Center | 4919 N Clark St, Chicago, IL 60640-3514 | 2020-10-01 |
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| Find all providers with the same taxonomy | ||||
| City | FAIRVIEW HEIGHTS |
| Zip Code | 62208 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.