MEDICARE: ST. JOHNS COMMUNITY HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	171W00000X	Contractor
3	251B00000X	Case Management Agency
4	251X00000X	Supports Brokerage Agency
5	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417469495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHNS COMMUNITY HEALTH

Provider Business Mailing Address
First Line	:	808 W 58TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-3632
Country	:	US
Telephone Number	:	323-541-1600
Fax Number	:	323-541-1661

Provider Business Practice Location Address
First Line	:	4251 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2536
Country	:	US
Telephone Number	:	323-541-1600
Fax Number	:	323-541-1661

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	JAMES MANGIA
Credential	:
Telephone Number	:	323-541-1601

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	11/09/2023

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