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General NPI Number Information
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NPI Number | 1609901016
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Entity Type | Organization
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Legal Business Name | PROVIDENCE SAINT JOHN'S HEALTH CENTER
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 1339 20TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-2033
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Country | US
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Telephone | 310-829-8921
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Fax | 310-829-8455
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Provider Business Mailing Address
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Address Line | 1339 20TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-2033
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Country | US
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Telephone | 310-829-8921
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Fax | 310-829-8455
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Authorized Official
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Title or Position | OUTPATIENT DIRECTOR
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Name | MRS. RUTH CANAS
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Credential | LCSW
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Telephone | 310-829-8921
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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 | 569538
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License Number State | CA
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