1649680588 NPI number — ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.

Table of content: (NPI 1649680588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649680588 NPI number — ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1649680588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 W 58TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90037-3632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-541-1600
Provider Business Mailing Address Fax Number:
323-541-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W WASHINGTON BLVD BLDG E-102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90015-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-541-1600
Provider Business Practice Location Address Fax Number:
323-541-1661
Provider Enumeration Date:
04/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MANGIA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
323-541-1600

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1649680588 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com