Organization
ELDERCARE, INC.
Active
Other names
Calvin Johnson Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN C. WOLF (PRESIDENT)
(618) 234-2273
Entity
Organization
Contact information
Practice address
727 NORTH 17TH STREET, BELLEVILLE, IL 62226-6599
(618) 234-3323
(618) 234-9477
Mailing address
2810 FRANK SCOTT PARKWAY WEST, SUITE 820, BELLESVILLE, IL 62223-5007
(618) 234-2273
(618) 234-7777
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
1400434197
IL
314000000X
Skilled Nursing Facility
Primary
0023309
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103025508
—
MO
01
—
V255P(657)0911
VA (VETERANS' ADMIN)
—
Enumeration date
12/01/2008
Last updated
08/17/2018
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