Provider Demographics
NPI:1679929368
Name:ST. MARYS HEALTH CARE CENTER INVESTORS LLC
Entity Type:Organization
Organization Name:ST. MARYS HEALTH CARE CENTER INVESTORS LLC
Other - Org Name:EDWARDSVILLE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF A/R
Authorized Official - Prefix:
Authorized Official - First Name:JAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-598-2645
Mailing Address - Street 1:401 SAINT MARYS DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4276
Mailing Address - Country:US
Mailing Address - Phone:618-692-1330
Mailing Address - Fax:618-692-9478
Practice Address - Street 1:401 SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4276
Practice Address - Country:US
Practice Address - Phone:618-692-1330
Practice Address - Fax:618-692-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801OtherMEDICAID DME