Provider Demographics
NPI:1366845380
Name:ST. JOSEPHS TOWER INC.
Entity Type:Organization
Organization Name:ST. JOSEPHS TOWER INC.
Other - Org Name:ST. JOSEPHS TOWER ICF DDN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESCARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-521-5235
Mailing Address - Street 1:3227 LA MADERA WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4969
Mailing Address - Country:US
Mailing Address - Phone:916-521-5235
Mailing Address - Fax:916-910-9186
Practice Address - Street 1:1844 C ST
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-5215
Practice Address - Country:US
Practice Address - Phone:916-521-5235
Practice Address - Fax:916-910-9186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-04
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities