MEDICARE: ST JUDE HOME CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1043782204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JUDE HOME CARE, INC

Provider Business Mailing Address
First Line	:	6880 HATHAWAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-7143
Country	:	US
Telephone Number	:	702-409-8957
Fax Number	:	702-437-1473

Provider Business Practice Location Address
First Line	:	6880 HATHAWAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-7143
Country	:	US
Telephone Number	:	702-409-8957
Fax Number	:	702-437-1473

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSE ABRIL
Credential	:
Telephone Number	:	702-409-8957

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	12/27/2018

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