Healthcare Provider Details

I. General information

NPI: 1972740116
Provider Name (Legal Business Name): ST. JUDE HOME HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 ALAMEDA ST
DOWNEY CA
90242-2434
US

IV. Provider business mailing address

8012 ALAMEDA ST
DOWNEY CA
90242-2434
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-2788
  • Fax: 562-622-2794
Mailing address:
  • Phone: 562-622-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA57788F
License Number StateCA

VIII. Authorized Official

Name: MRS. LETICIA SAMBELI
Title or Position: ADMINISTRATOR/DON
Credential: BSN-RN
Phone: 562-622-2788