Provider Demographics
NPI:1861151219
Name:ST JUDE'S HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:ST JUDE'S HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:O
Authorized Official - Last Name:FATIREGUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:313-398-6776
Mailing Address - Street 1:6029 E 14 MILE RD STE 200C
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5812
Mailing Address - Country:US
Mailing Address - Phone:313-398-6776
Mailing Address - Fax:586-272-2491
Practice Address - Street 1:6029 E 14 MILE RD STE 200C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5812
Practice Address - Country:US
Practice Address - Phone:313-398-6776
Practice Address - Fax:586-272-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI802564428OtherSTATE CORPORATE IDENTIFICATION NUMBER