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General NPI Number Information
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NPI Number | 1316387236
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Entity Type | Organization
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Legal Business Name | SAINT JOHNS HOSPITAL
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 141 E MAYWOOD STREET
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City | MORTON
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State | IL
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Zip | 61550
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Country | US
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Telephone | 309-642-8648
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Fax |
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Provider Business Mailing Address
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Address Line | 141 E MAYWOOD ST
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City | MORTON
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State | IL
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Zip | 61550
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Country | US
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Telephone | 309-642-8648
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | JENNIFER L GILSTRAP
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Credential |
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Telephone | 309-642-8648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 057002857
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License Number State | IL
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