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General NPI Number Information
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NPI Number | 1487229787
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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 | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 330 E. ORANGEWOOD AVE
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City | ANAHEIM
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State | CA
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Zip | 92802
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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 | CEO
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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