Provider Demographics
NPI:1821565771
Name:ST. JOHNS COMMUNITY HEALTH
Entity Type:Organization
Organization Name:ST. JOHNS COMMUNITY HEALTH
Other - Org Name:ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXCECTIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:SOCORRO
Authorized Official - Last Name:GENIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-541-1600
Mailing Address - Street 1:808 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3632
Mailing Address - Country:US
Mailing Address - Phone:323-541-1600
Mailing Address - Fax:323-541-1661
Practice Address - Street 1:1111 E ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5314
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:2018-10-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063836526Medicaid