Provider Demographics
NPI:1871581769
Name:ST. ANN'S HEALTHCARE CENTER, INC.
Entity type:Organization
Organization Name:ST. ANN'S HEALTHCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:618-826-2314
Mailing Address - Street 1:770 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1642
Mailing Address - Country:US
Mailing Address - Phone:618-826-2314
Mailing Address - Fax:618-826-5047
Practice Address - Street 1:770 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1642
Practice Address - Country:US
Practice Address - Phone:618-826-2314
Practice Address - Fax:618-826-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0023390314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid