| Organization Name: | ST JUDE HOME CARE OF THE FOUR STATES, LLC |
| NPI Number: | 1710315437 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORRIE JOSEPH GATLIN (SOLE MEMBER) |
| Mailing Address: | 501 S Pennsylvania Ave Joplin |
| State: | MO US |
| Postal Code: | 648012286 |
| Phone Number: | 4177170594 |
| Fax Number: | |
| NPI Enumeration Date: | 10/15/2013 |
| NPI Last Update Date: | 10/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |