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NPI Code Detail

MEDICARE: ST. JOHN OF GOD RETIREMENT AND CARE CENTER

MEDICARE: ST. JOHN OF GOD RETIREMENT AND CARE CENTER
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
1314000000XSkilled Nursing Facility970000022CA

Other Identifiers

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

General Provider Information

NPI Number : 1982693073
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOHN OF GOD RETIREMENT AND CARE CENTER
Provider Business Mailing Address
First Line : 2468 S ST ANDREWS PL
Second Line :
City : LOS ANGELES
State : CA
Zip : 90018-2042
Country : US
Telephone Number : 323-731-0641
Fax Number : 323-737-1452
Provider Business Practice Location Address
First Line : 2468 S ST ANDREWS PL
Second Line :
City : LOS ANGELES
State : CA
Zip : 90018-2042
Country : US
Telephone Number : 323-731-0641
Fax Number : 323-737-1452
Authorized Official
Title or Position : CEO
Name : MR. PATRICK OKEKE
Credential :
Telephone Number : 323-731-0641
Provider Enumeration Date : 10/20/2005
Last Update Date : 04/17/2009

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