Healthcare Provider Details

I. General information

NPI: 1710037650
Provider Name (Legal Business Name): MOUNT ST. JOSEPH-ST. ELIZABETH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 BRODERICK ST
SAN FRANCISCO CA
94115-2912
US

IV. Provider business mailing address

100 MASONIC AVE
SAN FRANCISCO CA
94118-4415
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-8370
  • Fax: 415-292-5531
Mailing address:
  • Phone: 415-567-8370
  • Fax: 415-292-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number380081BN
License Number StateCA

VIII. Authorized Official

Name: SISTER ESTELA MORALES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 415-351-4045