Provider Demographics
NPI:1700244571
Name:CHESTNUT HEALTH SYSTEMS
Entity Type:Organization
Organization Name:CHESTNUT HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF YOUTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MYCHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-827-6026
Mailing Address - Street 1:212 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:KAPPA
Mailing Address - State:IL
Mailing Address - Zip Code:61738-1855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 PEARL ST
Practice Address - Street 2:
Practice Address - City:KAPPA
Practice Address - State:IL
Practice Address - Zip Code:61738-1855
Practice Address - Country:US
Practice Address - Phone:309-261-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32510251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32510OtherCADC