Healthcare Provider Details

I. General information

NPI: 1952080731
Provider Name (Legal Business Name): ST. JUDE HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4506 IMPATIENS AVE N
BROOKLYN PARK MN
55443-1552
US

IV. Provider business mailing address

6160 SUMMIT DR N STE 320
MINNEAPOLIS MN
55430-2181
US

V. Phone/Fax

Practice location:
  • Phone: 612-245-5167
  • Fax: 952-314-9282
Mailing address:
  • Phone: 612-460-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY MING'ATE
Title or Position: ASSISTED LIVING DIRECTOR
Credential:
Phone: 612-245-5167