Provider Demographics
NPI:1952949687
Name:ARNESTA HEALTHCARE OF ILLINOIS
Entity Type:Organization
Organization Name:ARNESTA HEALTHCARE OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-313-6767
Mailing Address - Street 1:PO BOX 6843
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4912 W MARSHALL ST STE C
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3127
Practice Address - Country:US
Practice Address - Phone:804-313-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARNESTA HEALTHCARE COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)