Provider Demographics
NPI:1356452908
Name:ST. JOHN VILLAS INC.
Entity Type:Organization
Organization Name:ST. JOHN VILLAS INC.
Other - Org Name:FRANCES STREITEL VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-371-2545
Mailing Address - Street 1:2300 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-1625
Mailing Address - Country:US
Mailing Address - Phone:918-371-2545
Mailing Address - Fax:918-371-2738
Practice Address - Street 1:2300 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-1625
Practice Address - Country:US
Practice Address - Phone:918-371-2545
Practice Address - Fax:918-371-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7207-7207313M00000X
OK375504314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100777580AMedicaid
OK100777580AMedicaid