Provider Demographics
NPI:1265036263
Name:ST. JUDE CHILDREN'S RESEARCH HOSPITAL HOME CARE, LLC
Entity Type:Organization
Organization Name:ST. JUDE CHILDREN'S RESEARCH HOSPITAL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-595-1536
Mailing Address - Street 1:545 DANNY THOMAS PL RM J-1006
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 DANNY THOMAS PL RM J-1006
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3601
Practice Address - Country:US
Practice Address - Phone:901-595-1550
Practice Address - Fax:901-595-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health