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General NPI Number Information
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NPI Number | 1467706622
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Entity Type | Organization
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Legal Business Name | STJ LP
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 3833 E AVENUE R12
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City | PALMDALE
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State | CA
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Zip | 93550-2500
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Country | US
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Telephone | 661-382-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 13959 LA MAIDA ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-1906
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Country | US
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Telephone | 818-486-2273
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Fax | 818-907-8420
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. REGINA STERIN
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Credential |
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Telephone | 818-486-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 550002103
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License Number State | CA
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