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General NPI Number Information
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NPI Number | 1588151799
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Entity Type | Organization
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Legal Business Name | JP HOME CARE LLC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 1100 KENNESAW RIDGE RD UNIT 807
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City | COLUMBIA
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State | MO
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Zip | 65202
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Country | US
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Telephone | 773-332-6106
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Fax | 573-990-9999
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Provider Business Mailing Address
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Address Line | 303 MACAW DR
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City | COLUMBIA
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State | MO
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Zip | 65202
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Country | US
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Telephone | 773-332-6106
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | ZONDRA D CLARK
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Credential | REGISTERED NURSE
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Telephone | 773-332-6106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 00000
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License Number State | MO
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