St. Mary's Dining Room

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

ST. MARY'S DINING ROOM

Practice address

545 W Sonora St
Stockton, CA 95203-3329

Phone

(209) 467-0703

NPI assigned

Sep 19, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Petra Linden

Title

Chief Executive Officer

Phone

(209) 467-0703

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15974/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1063135762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 W SONORA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952033329",
            "telephone_number": "209-467-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 W SONORA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952033329",
            "telephone_number": "209-467-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S DINING ROOM",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-19",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "LINDEN",
        "authorized_official_first_name": "PETRA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "209-467-0703"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmoreno@stmarysdiningroom.org",
            "affiliation": "N",
            "endpointDescription": "e-mail address for Senior Director of Social Services",
            "address_1": "545 W Sonora St",
            "city": "Stockton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "952033329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Voluntary or Charitable Agency in Stockton, CA
• Providers in Stockton, CA by specialty
• Voluntary or Charitable Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.