Healthcare Provider Details

I. General information

NPI: 1780797829
Provider Name (Legal Business Name): ST THOMAS NURSING HOME PRIME LTD PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 BOLONGO BAY
ST THOMAS VI
00802-2806
US

IV. Provider business mailing address

7500 BOLONGO BAY
ST THOMAS VI
00802-2806
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-3303
  • Fax: 340-777-3323
Mailing address:
  • Phone: 340-777-3303
  • Fax: 340-777-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-10854-1L
License Number StateVI

VIII. Authorized Official

Name: MS. LINDA C PULLEY
Title or Position: CEO
Credential: RN, MPA,LNHA
Phone: 340-777-3303