Healthcare Provider Details

I. General information

NPI: 1205879061
Provider Name (Legal Business Name): SAINT JOHNS HOSPICE& PALLIATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N RUBY AVE
RULEVILLE MS
38771-3940
US

IV. Provider business mailing address

106 N RUBY AVE
RULEVILLE MS
38771-3940
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-0928
  • Fax: 662-756-0931
Mailing address:
  • Phone: 662-756-0928
  • Fax: 662-756-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number121
License Number StateMS

VIII. Authorized Official

Name: MRS. CAROLYN STEELE JOHNSON
Title or Position: RN/CEO
Credential: REGISTERED NURSE
Phone: 662-756-0928