St. John'S Healing Community Board

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

ST. JOHN'S HEALING COMMUNITY BOARD

Practice address

1015B Century Dr
Edwardsville, IL 62025-3772

Phone

(618) 656-7090

NPI assigned

Jul 13, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nancy Jo Berry

Title

Executive Director

Phone

(618) 344-5008

Specialties & licenses 1

Addresses

Tax ID family

St John'S Healing Community Board2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St. John'S Healing Community Board

  • Adult Day Care Clinic/Center
  • Collinsville, IL
  • NPI 1871712430
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531440000000",
    "number": "1083190920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 GOETHE AVE",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622343306",
            "telephone_number": "618-344-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015B CENTURY DR",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253772",
            "telephone_number": "618-656-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S HEALING COMMUNITY BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-13",
        "last_updated": "2018-07-13",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-344-5008",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Day Care Clinic/Center in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Adult Day Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.