Provider Demographics
NPI:1083397798
Name:ST VINCENT SENIOR CITIZEN NUTRITION PROGRAM
Entity Type:Organization
Organization Name:ST VINCENT SENIOR CITIZEN NUTRITION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:213-484-7775
Mailing Address - Street 1:2303 MIRAMAR ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2109
Mailing Address - Country:US
Mailing Address - Phone:213-484-7775
Mailing Address - Fax:
Practice Address - Street 1:2303 MIRAMAR ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2109
Practice Address - Country:US
Practice Address - Phone:213-484-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals