Provider Demographics
NPI:1528344553
Name:SAINT JUDE HOSPICE, LLC
Entity type:Organization
Organization Name:SAINT JUDE HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-221-9155
Mailing Address - Street 1:13375 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8261
Mailing Address - Country:US
Mailing Address - Phone:515-221-9155
Mailing Address - Fax:515-221-9157
Practice Address - Street 1:1660 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 223
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3069
Practice Address - Country:US
Practice Address - Phone:480-821-8338
Practice Address - Fax:480-897-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC4820251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031595Medicare Oscar/Certification