St. Luke Home Health Services, LLC
Organization Active NPI Home Health Agency · McComb, MS
NPI 1255401642 · NPPES record last updated May 17, 2017
Key facts
- NPI
- 1255401642
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 6081 (MS)
- Legal business name
- ST. LUKE HOME HEALTH SERVICES, LLC
- Practice address
- 210 State St
McComb, MS 39648-3939 - Phone
- (601) 249-4260
- Fax
- (601) 249-4292
- NPI assigned
- Nov 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Norman Price
- Title
- Chief Financial Officer
- Phone
- (601) 249-1807
Owners & managing parties with NPI records 11
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 4
Affiliated clinicians 81
-
Marcenia Aldridge, CNFP
-
Victor Anazia, DO
-
Carla Mitchell Armstrong, M.D.
-
Daniel Boone, DO
-
Constance M. Bradford, FNP-C
-
Alicia Brister, CFNP
-
Blaine Cooper Britt, M.D.
-
Destiny Grace Broom, FNP
-
James Turner Brown, M.D.
-
Johnny Bullock, MD
-
Bryan S Calcote, M.D.
-
Meghan Lynn Case, MD
-
Cody Caston Choate, D.O.
-
Brandon L Coleman, D. O.
-
Shelby Slade Dickerson, FNP-C
-
Susan L Dubose, FNP-BC
-
Joseph Lee Dykes, FNP
-
Paul G Dykes, MD
-
Nancy F Easterling, CFNP
Medicare Care Compare: Home health agency
- Listed as
- St Luke Home Health Services
- Overall star rating
- ★★★☆☆ 2.5 of 5
- Ownership
- Proprietary
- Certified
- Dec 26, 1978
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Home health agency certification: CCN 257124
- Legal name
- ST. LUKE HOME HEALTH SERVICES, LLC
- Doing business as
- ST. LUKE HOME HEALTH AND HOSPICE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Dec 26, 1978
- Last certification
- Oct 3, 2018
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Non-profit
- Incorporated
- Feb 22, 2002 in MS
- Enrollment address
- 210 State St
McComb, MS 39648-3939
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Southwest Mississippi Regional Medical Center |
5% Or Greater Indirect Ownership Interest | Oct 1, 2001 | 100% |
| St. Luke Foundation |
5% Or Greater Direct Ownership Interest | Feb 22, 2002 | 100% |
| Charla Rowley |
Corporate Officer |
Feb 1, 2020 | |
| Operational/Managerial Control |
Feb 1, 2020 | ||
| Norman Price |
Corporate Officer | Oct 1, 2001 | |
| Corporate Director | Feb 22, 2002 | ||
| W-2 Managing Employee | Feb 22, 2002 | ||
| Stephanie Bunch |
W-2 Managing Employee |
Sep 13, 2018 | |
| Operational/Managerial Control |
Sep 13, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080925000340 | MS | Part a Provider - Home Health Agency | 0749357242 | Practice locations: Brookhaven, MS; Monticello, MS; McComb, MS; Liberty, MS; Hattiesburg, MS; Columbia, MS; Collins, MS |
National Provider Directory
- Tax ID family
- St Luke Home Health Services LLC
Locations
210 State St
McComb, MS 39648
Phone (601) 249-4260
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 6081 | MS | Yes |
Addresses
Primary practice location
210 State St
McComb, MS 39648-3939
Mailing address
PO Box 1103
P. O. Box 1103
McComb, MS 39649-2735
Phone (601) 249-4260
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000070219 | Other | MS | BLUECROSSBLUESHIELD |
| 03927368 | Medicaid | MS |
Other providers in McComb, MS
- Nedra Spencer
- Pamela J Spiers-Jones
- Rachel Spiers
- Dana Spring
- Robin Bass Spring
- Lesia M Stallings
- Shaylia Standberry
- Monique C Starks
- Dennis W Starnes
- Statcare PLLC
All providers in McComb, MS · Home Health 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 May 17, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.