Provider Demographics
NPI:1093110926
Name:ST JUDE NURSING HOME INC
Entity Type:Organization
Organization Name:ST JUDE NURSING HOME INC
Other - Org Name:ST JUDE NURSING & REHAB FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-776-3013
Mailing Address - Street 1:PO BOX 9117
Mailing Address - Street 2:PLAZA CAROLINA STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9117
Mailing Address - Country:US
Mailing Address - Phone:787-776-3013
Mailing Address - Fax:787-762-9334
Practice Address - Street 1:1214 CALLE JOSE ABAD
Practice Address - Street 2:CLUB MANOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4336
Practice Address - Country:US
Practice Address - Phone:787-776-3013
Practice Address - Fax:787-762-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy