Sta-Home Hospice

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

023 Issued in MS

Legal business name

STA-HOME HOSPICE

Practice address

406 Briarwood Dr
Suite 500
Jackson, MS 39206-3039

Phone

(601) 991-1933

Fax

(601) 991-3343

NPI assigned

Jan 5, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Glenn D. Wood, RN

Title

Director of Compliance

Phone

(601) 956-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1821145285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 BRIARWOOD DR",
            "address_2": "SUITE 500",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063039",
            "telephone_number": "601-991-1933",
            "fax_number": "601-991-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 BRIARWOOD DR",
            "address_2": "SUITE 500",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063039",
            "telephone_number": "601-991-1933",
            "fax_number": "601-991-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STA-HOME HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "601-956-5100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MS",
            "license": "023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770002",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MS",
            "identifier": "000070004",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.