St Peter Villa Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

255 Issued in TN

Legal business name

ST PETER VILLA INC

Practice address

141 N McLean Blvd
Memphis, TN 38104-2693

Phone

(901) 276-2021

Fax

(901) 725-3564

NPI assigned

Oct 26, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kae Werhoven

Title

Administrator

Phone

(901) 276-2021

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447240882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 N MCLEAN BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042693",
            "telephone_number": "901-276-2021",
            "fax_number": "901-725-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 N MCLEAN BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042693",
            "telephone_number": "901-276-2021",
            "fax_number": "901-725-3564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PETER VILLA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WERHOVEN",
        "authorized_official_first_name": "KAE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "901-276-2021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440447",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in Memphis, TN
• Providers in Memphis, TN by specialty
• Nursing Facility/Intermediate Care Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.