Provider Demographics
NPI:1871712430
Name:ST. JOHN'S HEALING COMMUNITY BOARD
Entity type:Organization
Organization Name:ST. JOHN'S HEALING COMMUNITY BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:618-344-5008
Mailing Address - Street 1:222 GOETHE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3306
Mailing Address - Country:US
Mailing Address - Phone:618-344-5008
Mailing Address - Fax:618-344-4969
Practice Address - Street 1:222 GOETHE AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3306
Practice Address - Country:US
Practice Address - Phone:618-344-5008
Practice Address - Fax:618-344-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAD001-2002-2007OtherDEPT. OF REHABILITATION
IL96HM00649501OtherDEPT. OF RHABILITATION