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General NPI Number Information
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NPI Number | 1043416993
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH CENTER
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 1527 4TH ST FL 2
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City | SANTA MONICA
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State | CA
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Zip | 90401
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Country | US
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Telephone | 310-576-2550
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Fax | 310-576-2499
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Provider Business Mailing Address
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Address Line | 1527 4TH ST FL 2
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City | SANTA MONICA
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State | CA
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Zip | 90401-2358
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Country | US
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Telephone | 310-576-2550
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Fax | 310-576-2499
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. VA LECIA ADAMS KELLUM
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Credential | PH.D.
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Telephone | 310-396-6468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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