1194764563 NPI number — FRANCISCAN COMMUNITIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194764563 NPI number — FRANCISCAN COMMUNITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCAN COMMUNITIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. MARY HEALTHCARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194764563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 175TH ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60430-4610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-647-6500
Provider Business Mailing Address Fax Number:
708-647-6982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 CASON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47904-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-447-4102
Provider Business Practice Location Address Fax Number:
765-447-7386
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SR. VP/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
708-647-6500

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  06-000037-1 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100291350 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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