NPIMap

Organization Active NPI

Saint Jude Associates LLC

  • Community Based Hospice Care Agency
  • Las Vegas, NV
National Provider Identifier
1568034528
Registry record updated Jul 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SAINT JUDE ASSOCIATES LLC
Practice address
4412 W Charleston Blvd Ste B
Las Vegas, NV 89102-1636
Phone
(702) 476-8509
NPI assigned
Jul 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ricky Marion Asuncion Manalo, RN
Title
Director
Phone
(702) 945-8885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

4412 W Charleston Blvd Ste B
Las Vegas, NV 89102-1636

Mailing address

4412 W Charleston Blvd Ste B
Las Vegas, NV 89102-1636
Phone (702) 476-8509

Other identifiers 1

IdentifierTypeStateIssuer
NV20201968454OtherNVNEVADA STATE BUSINESS LICENSE

Other names 1

  • Saint Jude Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211221002274 NV Part A Provider - Hospice 6406247717 Practice locations: Las Vegas, NV

Hospice certification: CCN 291614

Legal name
SAINT JUDE ASSOCIATES LLC
Doing business as
SAINT JUDE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 27, 2022
Last certification
May 27, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Dec 16, 2020 in NV
Enrollment address
4412 W Charleston Blvd
Ste B
Las Vegas, NV 89102-1636

Care Compare: Hospice

Medicare Care Compare
Listed as
Saint Jude HospiceCCN 291614
Ownership
For-Profit
Certified
May 27, 2022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Saint Jude Associates LLC Organization, Las Vegas, NV Created for acquisition, LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 16, 2020 100%
Operational/Managerial Control Dec 16, 2020 100%
Ricky Marion Asuncion Manalo Individual 5% Or Greater Direct Ownership InterestDirector Dec 16, 2020 100%
Corporate OfficerDirector Dec 16, 2020 100%
Corporate DirectorDirector Dec 16, 2020 100%
W-2 Managing EmployeeDirector Dec 16, 2020 100%
Operational/Managerial ControlDirector Dec 16, 2020 100%

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625875200000",
    "number": "1568034528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4412 W CHARLESTON BLVD STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021636",
            "telephone_number": "702-476-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 W CHARLESTON BLVD STE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021636",
            "telephone_number": "702-476-8509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JUDE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-10",
        "last_updated": "2021-07-10",
        "certification_date": "2021-07-10",
        "status": "A",
        "authorized_official_last_name": "MANALO",
        "authorized_official_first_name": "RICKY MARION",
        "authorized_official_middle_name": "ASUNCION",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-945-8885",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA STATE BUSINESS LICENSE",
            "identifier": "NV20201968454",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Jude Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.