Provider Demographics
NPI:1326377227
Name:ST. JOSEPH CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
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 1:1848 LINCOLN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4580
Mailing Address - Country:US
Mailing Address - Phone:310-396-6556
Mailing Address - Fax:310-396-8437
Practice Address - Street 1:1848 LINCOLN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4580
Practice Address - Country:US
Practice Address - Phone:310-396-6556
Practice Address - Fax:310-396-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management