Provider Demographics
NPI:1972742799
Name:ST. JUDES SPECIALTY HOME AND HEALTH CARE SERVICES, INC
Entity type:Organization
Organization Name:ST. JUDES SPECIALTY HOME AND HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:956-740-0106
Mailing Address - Street 1:1220 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-6356
Mailing Address - Country:US
Mailing Address - Phone:956-740-0106
Mailing Address - Fax:956-727-1406
Practice Address - Street 1:1220 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-6356
Practice Address - Country:US
Practice Address - Phone:956-740-0106
Practice Address - Fax:956-727-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251E00000XOtherPTAN NUMBER
TX251E00000XOtherPTAN NUMBER
TX747388Medicare PIN