Provider Demographics
NPI:1942576236
Name:CHESTNUT HEALTH SYSTEMS
Entity Type:Organization
Organization Name:CHESTNUT HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTIONS COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CADC
Authorized Official - Phone:618-877-4420
Mailing Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6805
Mailing Address - Country:US
Mailing Address - Phone:618-877-4420
Mailing Address - Fax:618-877-9250
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6805
Practice Address - Country:US
Practice Address - Phone:618-877-4420
Practice Address - Fax:618-877-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder