Healthcare Provider Details

I. General information

NPI: 1407861222
Provider Name (Legal Business Name): ST. JUDE HOME HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12964 SW 133 CT.
MIAMI FL
33186
US

IV. Provider business mailing address

12964 SW 133 CT
MIAMI FL
33186
US

V. Phone/Fax

Practice location:
  • Phone: 305-235-9945
  • Fax: 305-251-4245
Mailing address:
  • Phone: 305-790-8484
  • Fax: 786-350-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299992339
License Number StateFL

VIII. Authorized Official

Name: VILMA CUENCA
Title or Position: PRESIDENT
Credential:
Phone: 305-790-8484