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NPI Code Detail

MEDICARE: ST PATRICK RESIDENCE

MEDICARE: ST PATRICK RESIDENCE
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
1314000000XSkilled Nursing Facility0035006IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000001152OTHERILBCBSIL PROVIDER NUMBER

General Provider Information

NPI Number : 1811982507
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST PATRICK RESIDENCE
Provider Business Mailing Address
First Line : 1400 BROOKDALE RD
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-2126
Country : US
Telephone Number : 630-416-6565
Fax Number : 630-416-8755
Provider Business Practice Location Address
First Line : 1400 BROOKDALE RD
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-2126
Country : US
Telephone Number : 630-416-6565
Fax Number : 630-416-8755
Authorized Official
Title or Position : ADMINISTRATOR
Name : SR. JEANNE HALEY
Credential :
Telephone Number : 630-416-6565
Provider Enumeration Date : 09/19/2005
Last Update Date : 12/13/2011

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Directions to “ST PATRICK RESIDENCE ” Practice Location

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