Provider Demographics
NPI:1437325123
Name:NEW WAY DEVELOPERS, INC.
Entity Type:Organization
Organization Name:NEW WAY DEVELOPERS, INC.
Other - Org Name:CHESTNUT MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-942-4578
Mailing Address - Street 1:1404 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-4125
Mailing Address - Country:US
Mailing Address - Phone:618-942-4578
Mailing Address - Fax:618-942-2328
Practice Address - Street 1:1404 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-4125
Practice Address - Country:US
Practice Address - Phone:618-942-4578
Practice Address - Fax:618-942-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0039958315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities