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General NPI Number Information
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NPI Number | 1750766697
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Entity Type | Organization
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Legal Business Name | ST. JOHN'S PERSONAL CARE SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 517 E BAKER ST
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City | INDIANOLA
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State | MS
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Zip | 38751-2503
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Country | US
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Telephone | 166-264-7766
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3 409 STATE STREET
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City | INDIANOLA
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State | MS
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Zip | 38751-0000
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Country | US
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Telephone | 662-647-1766
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. WILLIE BRADFORD, JR
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Credential |
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Telephone | 662-647-1766
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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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