Basic Information
| Provider Information | |||||||||
| NPI: | 1932250792 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINT ANTHONYS HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAINT ANTHONYS HEALTH CENTER SNU | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 340 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620020340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184652571 | ||||||||
| FaxNumber: | 6184635223 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 E 5TH ST | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184652571 | ||||||||
| FaxNumber: | 6184635223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESICENT CFO | ||||||||
| AuthorizedOfficialTelephone: | 6184652571 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.