Provider Demographics
NPI:1821113465
Name:ST. JUDE CATHOLIC HOSPITAL
Entity Type:Organization
Organization Name:ST. JUDE CATHOLIC HOSPITAL
Other - Org Name:FATHER PURCELL MEMORIAL EXCEPTIONAL CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:PALOMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:334-834-5590
Mailing Address - Street 1:2048 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-4196
Mailing Address - Country:US
Mailing Address - Phone:334-834-5590
Mailing Address - Fax:334-834-5602
Practice Address - Street 1:1820 OAK STRRET
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108
Practice Address - Country:US
Practice Address - Phone:334-834-5590
Practice Address - Fax:334-834-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN51043140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754450SMedicaid