Provider Demographics
NPI:1043416993
Name:ST. JOSEPH CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH CENTER
Other - Org Name:ST. JOSEPH CENTER - WISE & HEALTHY AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VA LECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS KELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-396-6468
Mailing Address - Street 1:1527 4TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2358
Mailing Address - Country:US
Mailing Address - Phone:310-576-2550
Mailing Address - Fax:310-576-2499
Practice Address - Street 1:1527 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401
Practice Address - Country:US
Practice Address - Phone:310-576-2550
Practice Address - Fax:310-576-2499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-26
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health