Provider Demographics
NPI:1649645573
Name:CHAMNESS CARE, INC
Entity type:Organization
Organization Name:CHAMNESS CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TWEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:618-833-4774
Mailing Address - Street 1:PO BOX I
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62952-0479
Mailing Address - Country:US
Mailing Address - Phone:618-833-4774
Mailing Address - Fax:618-833-5295
Practice Address - Street 1:1955 STATE ROUTE 146 E
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-3501
Practice Address - Country:US
Practice Address - Phone:618-833-4774
Practice Address - Fax:618-833-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL199400197S320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities