Provider Demographics
NPI:1558390716
Name:ST LUKES HEALTH CARE CENTER
Entity Type:Organization
Organization Name:ST LUKES HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-641-2177
Mailing Address - Street 1:3555 CESAR CHAVEZ
Mailing Address - Street 2:REDWOOD ESTATE BLDG
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4403
Mailing Address - Country:US
Mailing Address - Phone:415-641-2177
Mailing Address - Fax:415-641-2190
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 506
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4403
Practice Address - Country:US
Practice Address - Phone:415-641-2140
Practice Address - Fax:415-641-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11829FMedicaid
CAZZR11829FMedicaid