Provider Demographics
NPI:1538232483
Name:ST. JOHN VILLAS INC.
Entity type:Organization
Organization Name:ST. JOHN VILLAS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ST. JOHN VILLAS INC
Authorized Official - Prefix:
Authorized Official - First Name:SISTER CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-744-3072
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:523 N 22ND ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-1636
Practice Address - Country:US
Practice Address - Phone:918-371-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAL7218310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKAL7218OtherOSDH LICENSE