Provider Demographics
NPI:1255401642
Name:ST. LUKE HOME HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ST. LUKE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-249-1807
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:P. O. BOX 1103
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-2735
Mailing Address - Country:US
Mailing Address - Phone:601-249-4260
Mailing Address - Fax:601-249-4292
Practice Address - Street 1:210 STATE ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3939
Practice Address - Country:US
Practice Address - Phone:601-249-4260
Practice Address - Fax:601-249-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6081251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000070219OtherBLUECROSSBLUESHIELD
MS03927368Medicaid
MS03927368Medicaid