Provider Demographics
NPI:1013042852
Name:IL DEPT. OF HUMAN SERVICES
Entity Type:Organization
Organization Name:IL DEPT. OF HUMAN SERVICES
Other - Org Name:CHESTER MENTAL HEALTH CENTER, UNIT D (8761)
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT RESOURCE UNIT SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-826-4571
Mailing Address - Street 1:1315 LEHMEN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-2542
Mailing Address - Country:US
Mailing Address - Phone:618-826-4571
Mailing Address - Fax:618-826-3229
Practice Address - Street 1:1315 LEHMEN DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-2542
Practice Address - Country:US
Practice Address - Phone:618-826-4571
Practice Address - Fax:618-826-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL831000Medicare ID - Type Unspecified