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General NPI Number Information
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NPI Number | 1184092017
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Entity Type | Organization
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Legal Business Name | ST. JUDE NEIGHBORHOOD HEALTH CENTERS
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 1801 S GREENVILLE ST
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City | SANTA ANA
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State | CA
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Zip | 92704-4005
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Country | US
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Telephone | 714-446-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 731 S HIGHLAND AVE
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City | FULLERTON
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State | CA
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Zip | 92832-2753
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Country | US
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Telephone | 714-446-5100
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TIMOTHY JASON BROWN
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Credential |
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Telephone | 208-899-9631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 550000408
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 550000408
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License Number State | CA
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