Provider Demographics
NPI:1851797765
Name:ST. JOHN HOSPICE INC.
Entity Type:Organization
Organization Name:ST. JOHN HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-255-2505
Mailing Address - Street 1:14228 MIDWAY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3656
Mailing Address - Country:US
Mailing Address - Phone:734-255-2505
Mailing Address - Fax:
Practice Address - Street 1:14228 MIDWAY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3656
Practice Address - Country:US
Practice Address - Phone:734-255-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based