Provider Demographics
NPI:1932346228
Name:ST. ANSELM'S CROSS CULTURAL COMMUNITY CENTER
Entity Type:Organization
Organization Name:ST. ANSELM'S CROSS CULTURAL COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONNELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-537-0608
Mailing Address - Street 1:11277 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1340
Mailing Address - Country:US
Mailing Address - Phone:714-537-0608
Mailing Address - Fax:714-537-7606
Practice Address - Street 1:11277 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1340
Practice Address - Country:US
Practice Address - Phone:714-537-0608
Practice Address - Fax:714-537-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)