Provider Demographics
NPI:1073678165
Name:SAINT CLARES VILLA LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SAINT CLARES VILLA LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-465-2571
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-0340
Mailing Address - Country:US
Mailing Address - Phone:618-463-9000
Mailing Address - Fax:618-463-0995
Practice Address - Street 1:915 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6434
Practice Address - Country:US
Practice Address - Phone:618-463-9000
Practice Address - Fax:618-463-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid