Provider Demographics
NPI:1518209329
Name:ST JEAN SENIOR CARE
Entity Type:Organization
Organization Name:ST JEAN SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ILAGAN
Authorized Official - Last Name:ST JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-489-9297
Mailing Address - Street 1:6924 ACOMA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5305
Mailing Address - Country:US
Mailing Address - Phone:702-489-9297
Mailing Address - Fax:
Practice Address - Street 1:6924 ACOMA CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5305
Practice Address - Country:US
Practice Address - Phone:702-489-9297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5936AGZ-2311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)