Provider Demographics
NPI:1558359232
Name:ST. VINCENTS HOME, INC.
Entity Type:Organization
Organization Name:ST. VINCENTS HOME, INC.
Other - Org Name:ST VINCENTS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-224-3780
Mailing Address - Street 1:1440 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-1975
Mailing Address - Country:US
Mailing Address - Phone:217-224-3780
Mailing Address - Fax:217-224-3827
Practice Address - Street 1:1440 N 10TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-1975
Practice Address - Country:US
Practice Address - Phone:217-224-3780
Practice Address - Fax:217-224-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036723314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL145457Medicare Oscar/Certification