Provider Demographics
NPI:1821693854
Name:WP-ARC ST. JAMES HOLDINGS, LLC
Entity Type:Organization
Organization Name:WP-ARC ST. JAMES HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-595-6025
Mailing Address - Street 1:14335 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3681
Mailing Address - Country:US
Mailing Address - Phone:618-526-0100
Mailing Address - Fax:618-526-8730
Practice Address - Street 1:14335 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3681
Practice Address - Country:US
Practice Address - Phone:618-526-0100
Practice Address - Fax:618-526-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility