Healthcare Provider Details

I. General information

NPI: 1023169885
Provider Name (Legal Business Name): SAINT ANTHONYS HEALTH CENTER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E 5TH ST
ALTON IL
62002-6434
US

IV. Provider business mailing address

PO BOX 340
ALTON IL
62002-0340
US

V. Phone/Fax

Practice location:
  • Phone: 618-465-2571
  • Fax: 618-463-5223
Mailing address:
  • Phone: 618-465-2571
  • Fax: 618-463-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number002000362
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL L NELSON
Title or Position: EXECUTIVE VICE-PRESIDENT CFO
Credential:
Phone: 618-465-2571