Organization
STA-HOME HOSPICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN D. WOOD RN (DIRECTOR OF COMPLIANCE)
(601) 956-5100
Entity
Organization
Contact information
Practice address
406 BRIARWOOD DR, SUITE 500, JACKSON, MS 39206-3039
(601) 991-1933
(601) 991-3343
Mailing address
406 BRIARWOOD DR, SUITE 500, JACKSON, MS 39206-3039
(601) 991-1933
(601) 991-3343
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
023
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000070004
BCBS OF MS
MS
05
—
00770002
—
MS
Enumeration date
01/05/2007
Last updated
03/29/2017
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