Provider Demographics
NPI:1710037650
Name:MOUNT ST. JOSEPH-ST. ELIZABETH
Entity Type:Organization
Organization Name:MOUNT ST. JOSEPH-ST. ELIZABETH
Other - Org Name:EPIPHANY HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER ESTELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
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:415-567-8370
Mailing Address - Fax:415-292-5531
Practice Address - Street 1:1615 BRODERICK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2912
Practice Address - Country:US
Practice Address - Phone:415-567-8370
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:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380081BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility