Provider Demographics
NPI:1225114465
Name:ST. JOHN HOME CARE LLC
Entity Type:Organization
Organization Name:ST. JOHN HOME CARE LLC
Other - Org Name:ASCENSION AT HOME - TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:417-841-4834
Mailing Address - Fax:866-955-8535
Practice Address - Street 1:4612 S HARVARD AVE STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2908
Practice Address - Country:US
Practice Address - Phone:918-747-7901
Practice Address - Fax:844-724-7540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2265251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200289130AMedicaid
OK000377073001OtherBCBS
OK74104 0000OtherCHAMPUS
OK37-7073Medicare ID - Type Unspecified