Provider Demographics
NPI:1568034528
Name:SAINT JUDE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SAINT JUDE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY MARION
Authorized Official - Middle Name:ASUNCION
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-945-8885
Mailing Address - Street 1:4412 W CHARLESTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1636
Mailing Address - Country:US
Mailing Address - Phone:702-476-8509
Mailing Address - Fax:
Practice Address - Street 1:4412 W CHARLESTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1636
Practice Address - Country:US
Practice Address - Phone:702-476-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20201968454OtherNEVADA STATE BUSINESS LICENSE