Organization
ST JUDE HOME CARE OF THE FOUR STATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORRIE JOSEPH GATLIN (SOLE MEMBER)
(417) 717-0594
Entity
Organization
Contact information
Practice address
501 S PENNSYLVANIA AVE, JOPLIN, MO 64801-2286
(417) 717-0594
Mailing address
501 S PENNSYLVANIA AVE, JOPLIN, MO 64801-2286
(417) 717-0594
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
10/15/2013
Last updated
10/15/2013
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