Provider Demographics
NPI:1740577485
Name:ST. JOHN'S WELL CHILD AND FAMILY CENTER
Entity Type:Organization
Organization Name:ST. JOHN'S WELL CHILD AND FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-541-1600
Mailing Address - Street 1:5701 S HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-4045
Mailing Address - Country:US
Mailing Address - Phone:323-541-1600
Mailing Address - Fax:323-541-1661
Practice Address - Street 1:1112 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1427
Practice Address - Country:US
Practice Address - Phone:323-541-1600
Practice Address - Fax:323-541-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care