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NPI Code Detail

MEDICARE: ST PAULS SENIOR COMMUNITY LLC

MEDICARE: ST PAULS SENIOR COMMUNITY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility0013920IL

General Provider Information

NPI Number : 1710973284
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST PAULS SENIOR COMMUNITY LLC
Provider Business Mailing Address
First Line : 1021 W E ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1055
Country : US
Telephone Number : 618-233-2095
Fax Number : 618-233-2109
Provider Business Practice Location Address
First Line : 1021 W E ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1055
Country : US
Telephone Number : 618-233-2095
Fax Number : 618-233-2109
Authorized Official
Title or Position : MEDICARE BILLING SPECIALIST
Name : ELIZABETH ANN PAPIN
Credential :
Telephone Number : 636-222-0060
Provider Enumeration Date : 09/21/2005
Last Update Date : 05/14/2020

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Directions to “ST PAULS SENIOR COMMUNITY LLC ” Practice Location

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