MEDICARE: ST JOSEPH HEALTH SYSTEM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	05-005043-1	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740234111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH HEALTH SYSTEM LLC

Provider Business Mailing Address
First Line	:	15819 COLLECTION CENTER DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60693-0158
Country	:	US
Telephone Number	:	260-425-3000
Fax Number	:	260-425-3222

Provider Business Practice Location Address
First Line	:	700 BROADWAY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-1402
Country	:	US
Telephone Number	:	260-425-3000
Fax Number	:	260-425-3222

Authorized Official
Title or Position	:	DIRECTOR/DELEGATED OFFICIAL
Name	:	PAULA M LALOR
Credential	:
Telephone Number	:	629-215-3953

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/29/2021

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Directions to “ST JOSEPH HEALTH SYSTEM LLC ” Practice Location

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