1053437483 NPI number — ST. FRANCIS MEDICAL CENTER - CCC

Table of content: (NPI 1053437483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053437483 NPI number — ST. FRANCIS MEDICAL CENTER - CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. FRANCIS MEDICAL CENTER - CCC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. FRANCIS MEDICAL CENTER CHILD COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053437483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3630 E IMPERIAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90262-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-900-8490
Provider Business Mailing Address Fax Number:
310-632-6732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4390 TWEEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-6237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-609-6949
Provider Business Practice Location Address Fax Number:
323-583-6879
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOZAI
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
310-900-7301

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  93000157 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com