Provider Demographics
NPI:1730847385
Name:ST. JUDE HOME HEALTH CARE
Entity type:Organization
Organization Name:ST. JUDE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:818-426-7730
Mailing Address - Street 1:14545 FRIAR ST STE 322-3
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:747-264-0548
Mailing Address - Fax:747-264-1490
Practice Address - Street 1:14545 FRIAR ST
Practice Address - Street 2:STE.322-3
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:747-264-0548
Practice Address - Fax:747-264-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health