Provider Demographics
NPI:1861469041
Name:LUTHERAN HILLSIDE VILLAGE INC
Entity type:Organization
Organization Name:LUTHERAN HILLSIDE VILLAGE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:ATTN DIRECTOR OF REIMBURSEMENT
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 1:6901 N GALENA RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3193
Practice Address - Country:US
Practice Address - Phone:309-692-4600
Practice Address - Fax:309-589-8589
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SENIOR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-07
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0019109314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL145768Medicare Oscar/Certification