Healthcare Provider Details

I. General information

NPI: 1184098923
Provider Name (Legal Business Name): ST. BARNABAS SENIOR CENTER OF LOS ANGELES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S CARONDELET ST
LOS ANGELES CA
90057-3309
US

IV. Provider business mailing address

675 S CARONDELET ST
LOS ANGELES CA
90057-3309
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-4444
  • Fax: 213-738-9467
Mailing address:
  • Phone: 213-388-4444
  • Fax: 213-738-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN KOTICK
Title or Position: VP, PROGRAM & SERVICES
Credential:
Phone: 213-388-4444