Basic Information
| Provider Information | |||||||||
| NPI: | 1871823534 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. JOHN'S WELL CHILD AND FAMILY CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5701 S HOOVER ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900374045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235411600 | ||||||||
| FaxNumber: | 3235411661 | ||||||||
| Practice Location | |||||||||
| Address1: | 12338 S MONA BLVD | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902221320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108986010 | ||||||||
| FaxNumber: | 3106384935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2009 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | MANGIA | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 3235411600 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. JOHN'S WELL CHILD AND FAMILY CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.