Provider Demographics
NPI:1912992637
Name:SANTA TERESITA, INC.
Entity Type:Organization
Organization Name:SANTA TERESITA, INC.
Other - Org Name:SANTA TERESITA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:SISTER
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:MARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-289-1353
Mailing Address - Street 1:819 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1703
Mailing Address - Country:US
Mailing Address - Phone:626-408-7802
Mailing Address - Fax:626-408-7874
Practice Address - Street 1:819 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1703
Practice Address - Country:US
Practice Address - Phone:626-408-7802
Practice Address - Fax:626-408-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000125314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTX05139FMedicaid
CA055139Medicare ID - Type Unspecified