St. John'S Respite Care Services, LLC

Key facts

NPI: 1225580442
Entity type: Organization (NPI type 2)
Primary specialty: In Home Supportive Care Agency 253Z00000X
Legal business name: ST. JOHN'S RESPITE CARE SERVICES, LLC
Practice address: 517 East Street
Indianola, MS 38751
Phone: (662) 647-1766
NPI assigned: Nov 4, 2016
Organization subpart: No

Authorized official

Name: Mr. Willie Bradford Jr.
Title: Managing Director
Phone: (662) 647-1766

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

St. John'S Respite Care Services, LLC Respite Care · Indianola, MS · NPI 1275900813

NPD tax ID

National Provider Directory

Tax ID family: St John'S Respite Care Services LLC (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
In Home Supportive Care Agency	253Z00000X			Yes

Addresses

Primary practice location

517 East Street
Indianola, MS 38751

Mailing address

517 East Street
Indianola, MS 38751
Phone (662) 647-1766

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 4, 2016.

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1225580442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 EAST STREET",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "38751",
            "telephone_number": "662-647-1766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 EAST STREET",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "38751",
            "telephone_number": "662-647-1766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S RESPITE CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "662-647-1766",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianola, MS

All providers in Indianola, MS · In Home Supportive Care Agency in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.