MEDICARE: SAN JUDAS HOME CARE CORPORATION

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	310400000X	Assisted Living Facility	10118	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548448327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN JUDAS HOME CARE CORPORATION

Provider Business Mailing Address
First Line	:	10720 NW 5TH AVE.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168
Country	:	US
Telephone Number	:	561-871-0629
Fax Number	:	305-387-1555

Provider Business Practice Location Address
First Line	:	10720 NW 5TH AVE.
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33168
Country	:	US
Telephone Number	:	561-871-0629
Fax Number	:	305-387-1555

Authorized Official
Title or Position	:	OWNER
Name	:	ADILAIDIS LOYOLA
Credential	:
Telephone Number	:	305-796-1118

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	12/03/2025

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