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General NPI Number Information
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NPI Number | 1225114465
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Entity Type | Organization
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Legal Business Name | ST. JOHN HOME CARE LLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 4612 S HARVARD AVE STE C
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City | TULSA
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State | OK
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Zip | 74135-2908
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Country | US
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Telephone | 918-747-7901
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Fax | 844-724-7540
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Provider Business Mailing Address
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Address Line | 10 CADILLAC DR STE 400
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City | BRENTWOOD
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State | TN
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Zip | 37027-1001
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Country | US
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Telephone | 417-841-4834
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Fax | 866-955-8535
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Authorized Official
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Title or Position | SVP CHIEF LEGAL OFFICER
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Name | RUSSELL ADKINS
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Credential |
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Telephone | 615-309-5668
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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 | 2265
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License Number State | OK
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