Healthcare Provider Details

I. General information

NPI: 1306207386
Provider Name (Legal Business Name): PARK PLACE CHRISTIAN COMMUNITY OF ST. JOHN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10865 MAPLE LN SUITE C
SAINT JOHN IN
46373-8513
US

IV. Provider business mailing address

18601 N CREEK DR SUITE C
TINLEY PARK IL
60477-6397
US

V. Phone/Fax

Practice location:
  • Phone: 219-525-4658
  • Fax:
Mailing address:
  • Phone: 708-342-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD LEE NOLDEN
Title or Position: VP OF HEALTHCARE STRATEGY
Credential:
Phone: 708-342-8115