Provider Demographics
NPI:1679683544
Name:ST JUDE VISITING NURSES HOME HEALTH, INC
Entity Type:Organization
Organization Name:ST JUDE VISITING NURSES HOME HEALTH, INC
Other - Org Name:ST JUDE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-783-5833
Mailing Address - Street 1:6521 REMLAP ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-5311
Mailing Address - Country:US
Mailing Address - Phone:713-783-5833
Mailing Address - Fax:713-862-6833
Practice Address - Street 1:6521 REMLAP ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-5311
Practice Address - Country:US
Practice Address - Phone:713-783-5833
Practice Address - Fax:713-862-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010872251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453186Medicare Oscar/Certification