Provider Demographics
NPI:1063836526
Name:ST. JOHNS COMMUNITY HEALTH
Entity Type:Organization
Organization Name:ST. JOHNS COMMUNITY HEALTH
Other - Org Name:ST. JOHN'S WELL CHILD AND FAMILY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-541-1600
Mailing Address - Street 1:808 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3632
Mailing Address - Country:US
Mailing Address - Phone:323-541-1600
Mailing Address - Fax:323-541-1661
Practice Address - Street 1:3628 E IMPERIAL HWY STE 301
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2646
Practice Address - Country:US
Practice Address - Phone:323-541-1600
Practice Address - Fax:323-541-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage