Provider Demographics
NPI:1518208719
Name:CHESTNUT HEALTH SYSTEMS
Entity Type:Organization
Organization Name:CHESTNUT HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECOVERY SPECIALIST 1
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-877-4420
Mailing Address - Street 1:50 NORTHAGTE INDUSTRIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 NORTHAGTE INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-877-4420
Practice Address - Fax:618-876-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder