Illinois Medicaid-Substance Abuse Macomb

NPI #1588032460 in Macomb, Illinois

Provider Information

NPI Number: 1588032460
Entity Type: Organization
Organization Name: Illinois Medicaid-Substance Abuse Macomb
Subpart: Yes (part of a larger organization)
Parent Organization: BRIDGEWAY INC
Primary Specialty: Clinic/Center - Rehabilitation, Substance Use Disorder
Enumeration Date: Sep 9, 2015
Last Updated: Aug 19, 2019

Practice Location

Address: 900 S DEER RD
City: Macomb
State: Illinois
ZIP Code: 61455-2639
Phone: (309) 837-4876

Authorized Official

Name: MR. BILL A NELSON, LCPC
Title: CEO
Phone: (309) 344-4200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Psychiatry & Neurology - Child & Adolescent Psychiatry — Child & Adolescent Psychiatry	2084P0804X
Clinic/Center - Methadone — Methadone	261QM2800X
Clinic/Center - Rehabilitation, Substance Use Disorder — Rehabilitation, Substance Use Disorder	261QR0405X	Primary

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