Healthcare Provider Details

I. General information

NPI: 1588151799
Provider Name (Legal Business Name): JP HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 KENNESAW RIDGE RD UNIT 807
COLUMBIA MO
65202
US

IV. Provider business mailing address

303 MACAW DR
COLUMBIA MO
65202
US

V. Phone/Fax

Practice location:
  • Phone: 773-332-6106
  • Fax: 573-990-9999
Mailing address:
  • Phone: 773-332-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number00000
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ZONDRA D CLARK
Title or Position: DIRECTOR OF NURSING
Credential: REGISTERED NURSE
Phone: 773-332-6106