Provider Demographics
NPI:1306832050
Name:STJ HEALTHCARE, INC.
Entity Type:Organization
Organization Name:STJ HEALTHCARE, INC.
Other - Org Name:ST. CATHERINE'S OF BLOOMVILLE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-4662
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:22 CLINTON STREET
Mailing Address - City:BLOOMVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44818-0069
Mailing Address - Country:US
Mailing Address - Phone:419-983-2021
Mailing Address - Fax:419-983-4500
Practice Address - Street 1:22 CLINTON STREET
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-0069
Practice Address - Country:US
Practice Address - Phone:419-983-2021
Practice Address - Fax:419-983-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5850314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2086246Medicaid
OH365982Medicare ID - Type Unspecified