Provider Demographics
NPI:1922320795
Name:MERIDIAN VILLAGE ASSOCIATION
Entity Type:Organization
Organization Name:MERIDIAN VILLAGE ASSOCIATION
Other - Org Name:MERIDIAN VILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-968-9313
Mailing Address - Street 1:1150 HANLEY INDUSTRIAL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1910
Mailing Address - Country:US
Mailing Address - Phone:314-968-9313
Mailing Address - Fax:314-968-5590
Practice Address - Street 1:27 AUERBACH PLACE
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034
Practice Address - Country:US
Practice Address - Phone:618-288-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1957652314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371415587001Medicaid
IL146142Medicare Oscar/Certification