Provider Demographics
NPI:1871823534
Name:ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
Entity Type:Organization
Organization Name:ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
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 1:12338 S MONA BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1320
Practice Address - Country:US
Practice Address - Phone:310-898-6010
Practice Address - Fax:310-638-4935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHN'S WELL CHILD AND FAMILY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-31
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health