Provider Demographics
NPI:1588089338
Name:SAINT JUDE HOSPICE - MINNESOTA, LLC
Entity type:Organization
Organization Name:SAINT JUDE HOSPICE - MINNESOTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
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 1:1755 PRIOR AVE N
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113-5549
Practice Address - Country:US
Practice Address - Phone:515-221-9155
Practice Address - Fax:515-221-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based