Healthcare Provider Details

I. General information

NPI: 1801812284
Provider Name (Legal Business Name): ST. PAULS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N CALIFORNIA AVE
CHICAGO IL
60618-3606
US

IV. Provider business mailing address

3800 N CALIFORNIA AVE
CHICAGO IL
60618-3606
US

V. Phone/Fax

Practice location:
  • Phone: 773-478-4222
  • Fax: 773-478-4516
Mailing address:
  • Phone: 773-478-4222
  • Fax: 773-478-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0005165
License Number StateIL

VIII. Authorized Official

Name: MR. ROGER W PAULSBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 847-368-7300