Provider Demographics
NPI:1740424183
Name:ST. JOSEPH CENTER HOMELESS SERVICE
Entity Type:Organization
Organization Name:ST. JOSEPH CENTER HOMELESS SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIORINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-396-6468
Mailing Address - Street 1:404 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2829
Mailing Address - Country:US
Mailing Address - Phone:310-399-6878
Mailing Address - Fax:310-399-1339
Practice Address - Street 1:404 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2829
Practice Address - Country:US
Practice Address - Phone:310-399-6878
Practice Address - Fax:310-399-1339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-29
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health