=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972742799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. JUDES SPECIALTY HOME AND HEALTH CARE SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2009
-----------------------------------------------------
Last Update Date | 12/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 SCOTT ST
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78040-6356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-740-0106
-----------------------------------------------------
Fax | 956-727-1406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1220 SCOTT ST
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78040-6356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-740-0106
-----------------------------------------------------
Fax | 956-727-1406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. PATRICIA GUAJARDO
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 956-740-0106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------