MEDICARE: ST. JUDE CHILDREN'S RESEARCH HOSPITAL HOME CARE, LLC

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

General Provider Information

NPI Number	:	1265036263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JUDE CHILDREN'S RESEARCH HOSPITAL HOME CARE, LLC

Provider Business Mailing Address
First Line	:	545 DANNY THOMAS PL RM J-1006
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38105-3601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 DANNY THOMAS PL STE K1250
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38105-3601
Country	:	US
Telephone Number	:	901-595-1550
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND ADMINISTRATOR
Name	:	SHAYLA WILLIAMSON
Credential	:
Telephone Number	:	901-595-1536

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	06/25/2024

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