Provider Demographics
NPI: | 1952449316 |
---|---|
Name: | MOUNT ST. JOSEPH-ST. ELIZABETH |
Entity Type: | Organization |
Organization Name: | MOUNT ST. JOSEPH-ST. ELIZABETH |
Other - Org Name: | EPIPHANY RESIDENTIAL PROGRAM |
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: | 100 MASONIC AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94118-4415 |
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: | 2007-02-01 |
Last Update Date: | 2013-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |