Basic Information
| Provider Information | |||||||||
| NPI: | 1881893790 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. ANNE'S MATERNITY HOME | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 N OCCIDENTAL BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900264641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133812931 | ||||||||
| FaxNumber: | 2133817804 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 N OCCIDENTAL BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900264641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133812931 | ||||||||
| FaxNumber: | 2133817804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | DANA | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 2133812931 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7666 | 01 | CA | LA COUNTY DMH PROVIDER # | OTHER |