Provider Demographics
NPI:1649558792
Name:CHESNTUT HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:CHESNTUT HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-877-4420
Mailing Address - Street 1:20 KENSINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5007
Mailing Address - Country:US
Mailing Address - Phone:618-234-4429
Mailing Address - Fax:
Practice Address - Street 1:20 KENSINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5007
Practice Address - Country:US
Practice Address - Phone:618-234-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04023251B00000X, 251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211620Medicare PIN