Provider Demographics
NPI:1699825521
Name:MOUNT ST. JOSEPH-ST. ELIZABETH
Entity Type:Organization
Organization Name:MOUNT ST. JOSEPH-ST. ELIZABETH
Other - Org Name:EPIPHANY FAMILY TREATMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER BETTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-351-4045
Mailing Address - Street 1:100 MASONIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4415
Mailing Address - Country:US
Mailing Address - Phone:415-351-4054
Mailing Address - Fax:415-292-5531
Practice Address - Street 1:100 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-4415
Practice Address - Country:US
Practice Address - Phone:415-351-4054
Practice Address - Fax:415-292-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380081CN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health