Healthcare Provider Details

I. General information

NPI: 1871712430
Provider Name (Legal Business Name): ST. JOHN'S HEALING COMMUNITY BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 GOETHE AVE
COLLINSVILLE IL
62234-3306
US

IV. Provider business mailing address

222 GOETHE AVE
COLLINSVILLE IL
62234-3306
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-5008
  • Fax: 618-344-4969
Mailing address:
  • Phone: 618-344-5008
  • Fax: 618-344-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NANCY J. BERRY
Title or Position: EXECUTIVE DIRECTOR
Credential: MHA
Phone: 618-344-5008