MEDICARE: ST. JOSEPH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407115918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH CENTER

Provider Business Mailing Address
First Line	:	204 HAMPTON DR
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90291-2623
Country	:	US
Telephone Number	:	310-396-6468
Fax Number	:	310-392-8402

Provider Business Practice Location Address
First Line	:	8533 WASHINGTON BLVD STE A
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-7462
Country	:	US
Telephone Number	:	310-396-6468
Fax Number	:	310-392-8402

Authorized Official
Title or Position	:	DIRECTOR OF QA/CLINICAL SERVICES
Name	:	MANDY SOMMERS
Credential	:
Telephone Number	:	310-396-6468

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	02/27/2023

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