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General NPI Number Information
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NPI Number | 1821693854
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Entity Type | Organization
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Legal Business Name | WP-ARC ST. JAMES HOLDINGS, LLC
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 14335 JAMESTOWN RD
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City | BREESE
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State | IL
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Zip | 62230-3681
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Country | US
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Telephone | 618-526-0100
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Fax | 618-526-8730
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Provider Business Mailing Address
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Address Line | 14335 JAMESTOWN RD
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City | BREESE
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State | IL
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Zip | 62230-3681
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Country | US
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Telephone | 618-526-0100
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Fax | 618-526-8730
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Authorized Official
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Title or Position | REIMBURSEMENT ANALYST
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Name | MR. HENRY JAMES VAUGHN
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Credential |
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Telephone | 240-595-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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