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General NPI Number Information
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NPI Number | 1053380717
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Entity Type | Organization
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Legal Business Name | JEFFERSON COUNTY PATIENT CARE SERVICES
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10679 HIGHWAY 21
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City | HILLSBORO
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State | MO
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Zip | 63050-5094
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Country | US
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Telephone | 636-797-4913
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Fax | 636-797-5876
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Provider Business Mailing Address
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Address Line | 10679 HIGHWAY 21
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City | HILLSBORO
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State | MO
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Zip | 63050-5094
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Country | US
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Telephone | 636-797-4913
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Fax | 636-797-5876
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LAURA D JACKSON
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Credential | RN, MPH
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Telephone | 636-797-4913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 263-18
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License Number State | MO
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