Provider Demographics
NPI:1144216474
Name:ST JAMES HOSPTIAL
Entity Type:Organization
Organization Name:ST JAMES HOSPTIAL
Other - Org Name:ALVERNO HOME INFUSION SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:SENESAC
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:708-756-1000
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60412-0747
Mailing Address - Country:US
Mailing Address - Phone:708-709-2165
Mailing Address - Fax:708-709-2027
Practice Address - Street 1:1400 OTTO BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3871
Practice Address - Country:US
Practice Address - Phone:708-709-2165
Practice Address - Fax:708-709-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========012Medicaid
IL0289070003Medicare NSC