CHESTNUT HEALTH SYSTEMS (NPI# 1801069059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801069059 |
| Entity Type | Organization |
| Organization Name | CHESTNUT HEALTH SYSTEMS |
| Practice Address |
2148 Vadalabene Dr Maryville IL 62062-5632 |
| Mailing Address |
1003 Martin Luther King Dr Bloomington IL 61701-1429 |
| Practice Telephone | 6182883100 |
| Practice Fax Number | 6182882278 |
| Mailing Telephone | 3098276026 |
| Mailing Fax Number | 3098203574 |
| Enumeration Date | 2008-04-09 |
| 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 |
|---|---|---|---|---|---|
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
0126-0006 | IL | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | C/A 0126-0006-A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518208719 | Chestnut Health Systems | Clinic/Center | 110 Northagte Industrial Drive, Granite City, IL 62040 | 2013-03-13 |
| 1265773188 | Chestnut Health Systems | Community/Behavioral Health | 50 Northgate Industrial Dr # B, Granite City, IL 62040-6805 | 2013-03-04 |
| 1700244571 | Chestnut Health Systems | Community/Behavioral Health | 212 Pearl St, Kappa, IL 61738-1855 | 2016-02-08 |
| 1942647169 | Chestnut Health Systems | Counselor | 50 Northgate Industrial Dr, Granite City, IL 62040-6805 | 2013-05-29 |
| 1942576236 | Chestnut Health Systems | Clinic/Center | 50 Northgate Industrial Dr, Granite City, IL 62040-6805 | 2012-03-30 |
| 1609021997 | Chestnut Health Systems | Substance Abuse Rehabilitation Facility | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2008-12-01 |
| 1316068471 | Chestnut Health Systems | Clinic/Center | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2007-04-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Chestnut Health Systems Inc. | 1003 Martin Luther King Dr, Bloomington, Illinois 61701 |
| 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 |
| Indiana Business Entities | CHESTNUT HEALTH SYSTEMS, INC. | 1003 Martin Luther King Dr, Bloomington, IL 61701 |
| Street Address |
2148 VADALABENE DR |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-5632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801002142 | Mackenzie R Pherigo | Social Worker | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2007-05-15 |
| 1699316877 | Terry Glenn | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2019-09-30 |
| 1144750605 | Rebecca Leigh Salah | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2017-06-18 |
| 1649726340 | William Michael Weiss I | Registered Nurse | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2016-09-01 |
| 1497115315 | Kolin Smith | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2016-03-04 |
| 1750740544 | Larry Copp | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2016-02-22 |
| 1750719142 | Courtney L Hupp | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2013-10-22 |
| 1568719797 | Daniel Douglas Hutchison | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2012-08-07 |
| 1952677510 | Tracey Sue Pearson | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2012-03-28 |
| 1518232891 | Jamie Lee Garman | Counselor | 2148 Vadalabene Dr, Maryville, IL 62062-5632 | 2012-03-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740841840 | Avance Inc. | Substance Abuse Rehabilitation Facility | 4765 N Lincoln Ave, Chicago, IL 60625-2077 | 2019-06-28 |
| 1265966832 | Jacqueline Calles | Substance Abuse Rehabilitation Facility | 4904 W. 32nd St, Cicero, IL 60804 | 2017-04-20 |
| 1891001723 | Ford County Court Services | Substance Abuse Rehabilitation Facility | 200 W State St, Paxton, IL 60957-1179 | 2010-08-30 |
| 1558599803 | Rosecrance, Inc. | Substance Abuse Rehabilitation Facility | 215 N. Court Street, Methodist Church, Rockford, IL 61103-6802 | 2009-06-25 |
| 1508009234 | Woodford County | Substance Abuse Rehabilitation Facility | 105 E Court St, Eureka, IL 61530 | 2009-04-10 |
| 1326216151 | Lutheran Social Services of Illinois | Substance Abuse Rehabilitation Facility | 1261 Il Rte 38, Nachusa, IL 61057 | 2008-02-14 |
| 1275744385 | Lutheran Social Services of Illinois | Substance Abuse Rehabilitation Facility | 1261 Illinois Route# 38, Phoenix Unit, Nachusa, IL 61057-0100 | 2007-05-24 |
| 1386779445 | Gateway Foundation, Inc | Substance Abuse Rehabilitation Facility | 55 E Jackson Blvd, Suite 1500, Chicago, IL 60604-4466 | 2007-02-22 |
| 1841249372 | Nexus Family Healing | Substance Abuse Rehabilitation Facility | 118 East Lincoln Street, Onarga, IL 60955 | 2006-05-10 |
| 1366431686 | Chestnut Health Systems Inc | Substance Abuse Rehabilitation Facility | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 | 2005-10-19 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CHESTNUT HEALTH SYSTEMS.
| 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.