Organization
ST. JOHN HOME CARE LLC
Active
Parent organization
ST JOHN MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST JOHN MEDICAL CENTER
Authorized official
SR. M. THERESE GOTTSCHALK (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(918) 744-2180
Entity
Organization
Contact information
Practice address
4720 S HARVARD AVE STE 202, TULSA, OK 74135-3071
(918) 747-7901
Mailing address
4720 S HARVARD AVE STE 202, TULSA, OK 74135-3071
(918) 747-7901
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
2265
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000371506001
BCBS
OK
05
—
100699400A
—
OK
01
—
74104 0000
CHAMPUS
OK
Enumeration date
10/19/2006
Last updated
08/27/2010
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