Healthcare Provider Details

I. General information

NPI: 1982693073
Provider Name (Legal Business Name): ST. JOHN OF GOD RETIREMENT AND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 S ST ANDREWS PL
LOS ANGELES CA
90018-2042
US

IV. Provider business mailing address

2468 S ST ANDREWS PL
LOS ANGELES CA
90018-2042
US

V. Phone/Fax

Practice location:
  • Phone: 323-731-0641
  • Fax: 323-737-1452
Mailing address:
  • Phone: 323-731-0641
  • Fax: 323-737-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number970000022
License Number StateCA

VIII. Authorized Official

Name: MR. PATRICK OKEKE
Title or Position: CEO
Credential:
Phone: 323-731-0641