Provider Demographics
NPI:1952080731
Name:ST. JUDE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ST. JUDE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MING'ATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-245-5167
Mailing Address - Street 1:6160 SUMMIT DR N STE 320
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2181
Mailing Address - Country:US
Mailing Address - Phone:612-460-0018
Mailing Address - Fax:
Practice Address - Street 1:4506 IMPATIENS AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1552
Practice Address - Country:US
Practice Address - Phone:612-245-5167
Practice Address - Fax:952-314-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances