Healthcare Provider Details

I. General information

NPI: 1528141884
Provider Name (Legal Business Name): ST JUDE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 CALLE JOSE ABAD CLUB MANOR
RIO PIEDRAS PR
00924-4336
US

IV. Provider business mailing address

PO BOX 9117 PLAZA CAROLINA STATION
CAROLINA PR
00988-9117
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-3013
  • Fax: 787-757-3439
Mailing address:
  • Phone: 787-776-3013
  • Fax: 787-757-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4
License Number StatePR

VIII. Authorized Official

Name: HECTOR E JACA
Title or Position: CEO
Credential:
Phone: 787-776-3013