Provider Demographics
NPI:1215595392
Name:ST. JOSEPH CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA SOCORRO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-396-6468
Mailing Address - Street 1:8525 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3334
Mailing Address - Country:US
Mailing Address - Phone:323-905-1140
Mailing Address - Fax:323-905-1163
Practice Address - Street 1:8525 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-3334
Practice Address - Country:US
Practice Address - Phone:323-905-1140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)