MEDICARE: STJ HOME CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003229915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STJ HOME CARE INC.

Provider Business Mailing Address
First Line	:	6251 PARK BLVD N
Second Line	:	SUITE 7
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3238
Country	:	US
Telephone Number	:	727-804-9928
Fax Number	:

Provider Business Practice Location Address
First Line	:	6251 PARK BLVD N
Second Line	:	SUITE 7
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3238
Country	:	US
Telephone Number	:	727-804-9928
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	REBECCA MOULTRIE
Credential	:
Telephone Number	:	727-804-9928

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/12/2014

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