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General NPI Number Information
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NPI Number | 1821145285
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Entity Type | Organization
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Legal Business Name | STA-HOME HOSPICE
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 406 BRIARWOOD DR SUITE 500
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City | JACKSON
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State | MS
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Zip | 39206-3039
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Country | US
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Telephone | 601-991-1933
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Fax | 601-991-3343
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Provider Business Mailing Address
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Address Line | 406 BRIARWOOD DR SUITE 500
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City | JACKSON
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State | MS
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Zip | 39206-3039
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Country | US
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Telephone | 601-991-1933
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Fax | 601-991-3343
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | MR. GLENN D. WOOD
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Credential | RN
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Telephone | 601-956-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 023
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License Number State | MS
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