Provider Demographics
NPI:1962069393
Name:ST JOHN COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:ST JOHN COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-0520
Mailing Address - Street 1:2112 S GAREY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5600
Mailing Address - Country:US
Mailing Address - Phone:909-464-0520
Mailing Address - Fax:
Practice Address - Street 1:2112 S GAREY AVE STE C
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5600
Practice Address - Country:US
Practice Address - Phone:909-464-0520
Practice Address - Fax:909-464-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care