Provider Demographics
NPI:1467962167
Name:ST. JOSEPH COMMUNITY CO-OPERATIVE, INC.
Entity Type:Organization
Organization Name:ST. JOSEPH COMMUNITY CO-OPERATIVE, INC.
Other - Org Name:ST JOE CO-OP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:KRYSTINE
Authorized Official - Last Name:BOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-659-4525
Mailing Address - Street 1:307 W CHICAGO RD STE 210
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1675
Mailing Address - Country:US
Mailing Address - Phone:269-659-4525
Mailing Address - Fax:269-659-4528
Practice Address - Street 1:307 W CHICAGO RD STE 210
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1675
Practice Address - Country:US
Practice Address - Phone:269-659-4525
Practice Address - Fax:269-659-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385H00000XRespite Care FacilityRespite Care