St Jude Home Care of the Four States, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

ST JUDE HOME CARE OF THE FOUR STATES, LLC

Practice address

501 S Pennsylvania Ave
Joplin, MO 64801-2286

Phone

(417) 717-0594

NPI assigned

Oct 15, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Corrie Joseph Gatlin

Title

Sole Member

Phone

(417) 717-0594

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381795200000",
    "number": "1710315437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S PENNSYLVANIA AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648012286",
            "telephone_number": "417-717-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S PENNSYLVANIA AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648012286",
            "telephone_number": "417-717-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE HOME CARE OF THE FOUR STATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-15",
        "last_updated": "2013-10-15",
        "status": "A",
        "authorized_official_last_name": "GATLIN",
        "authorized_official_first_name": "CORRIE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "417-717-0594",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Joplin, MO
• Providers in Joplin, MO by specialty
• In Home Supportive Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.