Provider Demographics
NPI:1659596963
Name:MOUNT SINAI HEALTHCARE INC.
Entity Type:Organization
Organization Name:MOUNT SINAI HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OFOMATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-290-2001
Mailing Address - Street 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:#507
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-290-2001
Mailing Address - Fax:323-290-2003
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:#507
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-290-2001
Practice Address - Fax:323-290-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7007251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health