Provider Demographics
NPI:1689968794
Name:ST PAUL CENTER 1
Entity Type:Organization
Organization Name:ST PAUL CENTER 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORETA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-831-1979
Mailing Address - Street 1:405 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1878
Mailing Address - Country:US
Mailing Address - Phone:661-325-9720
Mailing Address - Fax:
Practice Address - Street 1:405 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1878
Practice Address - Country:US
Practice Address - Phone:661-325-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health