Provider Demographics
NPI:1215021043
Name:STJ HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:STJ HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:ADEOLA
Authorized Official - Last Name:ADENOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-251-0664
Mailing Address - Street 1:11302 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4653
Mailing Address - Country:US
Mailing Address - Phone:832-251-0664
Mailing Address - Fax:832-251-0886
Practice Address - Street 1:11302 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4653
Practice Address - Country:US
Practice Address - Phone:832-251-0664
Practice Address - Fax:832-251-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010333251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679369Medicare PIN
TX679369Medicare Oscar/Certification