Provider Demographics
NPI:1114977410
Name:ST. JUDE HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ST. JUDE HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:DEL ROSARIO
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:786-268-7812
Mailing Address - Street 1:6356 MANOR LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:786-268-7812
Mailing Address - Fax:786-268-7813
Practice Address - Street 1:6356 MANOR LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:786-268-7812
Practice Address - Fax:786-268-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992322251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108332Medicare PIN