Healthcare Provider Details

I. General information

NPI: 1306832050
Provider Name (Legal Business Name): STJ HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CLINTON STREET
BLOOMVILLE OH
44818-0069
US

IV. Provider business mailing address

PO BOX 69 22 CLINTON STREET
BLOOMVILLE OH
44818-0069
US

V. Phone/Fax

Practice location:
  • Phone: 419-983-2021
  • Fax: 419-983-4500
Mailing address:
  • Phone: 419-983-2021
  • Fax: 419-983-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5850
License Number StateOH

VIII. Authorized Official

Name: MRS. CHERYL BARNHART
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-447-4662