=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770636656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. JOHNS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 7TH ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67671-9527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-735-2208
-----------------------------------------------------
Fax | 785-735-2270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 7TH ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67671-9527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-735-2208
-----------------------------------------------------
Fax | 785-735-2270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FINANCE
-----------------------------------------------------
Name | WILLIAM J SLATER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-946-5215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | N026004
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------