Provider Demographics
NPI:1609321173
Name:SAINT JOHN'S COMMUNITIES, INC.
Entity Type:Organization
Organization Name:SAINT JOHN'S COMMUNITIES, INC.
Other - Org Name:SAINT JOHN'S COMMUNITIES, INC. CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-831-6880
Mailing Address - Street 1:1840 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1975
Mailing Address - Country:US
Mailing Address - Phone:414-272-2022
Mailing Address - Fax:414-212-8161
Practice Address - Street 1:1840 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1975
Practice Address - Country:US
Practice Address - Phone:414-272-2022
Practice Address - Fax:414-212-8161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT JOHN'S COMMUNITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center