MEDICARE: MOUNT ST. JOSEPH-ST. ELIZABETH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	380081BN	CA

General Provider Information

NPI Number	:	1710037650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT ST. JOSEPH-ST. ELIZABETH

Provider Business Mailing Address
First Line	:	100 MASONIC AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-4415
Country	:	US
Telephone Number	:	415-567-8370
Fax Number	:	415-292-5531

Provider Business Practice Location Address
First Line	:	1615 BRODERICK ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2912
Country	:	US
Telephone Number	:	415-567-8370
Fax Number	:	415-292-5531

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SISTER ESTELA MORALES
Credential	:
Telephone Number	:	415-351-4045

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	08/26/2013

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