Provider Demographics
NPI:1467655605
Name:ST JUDE'S HOME INC
Entity Type:Organization
Organization Name:ST JUDE'S HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUORAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCHP
Authorized Official - Phone:281-337-5390
Mailing Address - Street 1:3113 BAY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3922
Mailing Address - Country:US
Mailing Address - Phone:281-337-5390
Mailing Address - Fax:281-614-5788
Practice Address - Street 1:3113 BAY CREEK DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3922
Practice Address - Country:US
Practice Address - Phone:281-337-5390
Practice Address - Fax:281-614-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X, 320900000X, 320900000X, 320900000X, 320900000X, 320900000X, 320900000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities