Basic Information
| Provider Information | |||||||||
| NPI: | 1346378270 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST FRANCIS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3630 E IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109007421 | ||||||||
| FaxNumber: | 3106036586 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 E IMPERIAL HWY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902622609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109007421 | ||||||||
| FaxNumber: | 3106036586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BASTOS | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT FINANCIAL SERVICRES DIRECTO | ||||||||
| AuthorizedOfficialTelephone: | 3109007421 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | LTC55238G | 05 | CA | MEDICAID |