Healthcare Provider Details

I. General information

NPI: 1730342999
Provider Name (Legal Business Name): MT. ST. JOSEPH-ST. ELIZABETH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MASONIC AVE
SAN FRANCISCO CA
94118-4415
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 Number380081CN
License Number StateCA

VIII. Authorized Official

Name: MS. JEAN POPE
Title or Position: SUBSTANCE ABUSE TREATMENT COOR.
Credential:
Phone: 405-567-8370