Provider Demographics
NPI:1306207386
Name:PARK PLACE CHRISTIAN COMMUNITY OF ST. JOHN, INC.
Entity Type:Organization
Organization Name:PARK PLACE CHRISTIAN COMMUNITY OF ST. JOHN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF HEALTHCARE STRATEGY
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-342-8115
Mailing Address - Street 1:18601 N CREEK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6397
Mailing Address - Country:US
Mailing Address - Phone:708-342-8115
Mailing Address - Fax:
Practice Address - Street 1:10865 MAPLE LN
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8513
Practice Address - Country:US
Practice Address - Phone:219-525-4658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility