- Enrollment id
- O20040405000435
- Enrollment state
- MO
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1366570079
- Multiple npi flag
- N
- Ccn
- 265733
- Associate id
- 6901899236
- Organization name
- ST JOHNS PLACE INC
- Doing business as name
- ST JOHNS PLACE
- Incorporation date
- 2003-12-05
- Incorporation state
- MO
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Nursing home provider name
- ST JOHNS PLACE
- Address line 1
- 3333 BROWN RD
- City
- SAINT LOUIS
- State
- MO
- Zip code
- 631144327