NPIMap

Organization Active NPI

Providence Saint John'S Health Center

  • Community/Behavioral Health Agency
  • Santa Monica, CA
National Provider Identifier
1609901016
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
569538 Issued in CA
Legal business name
PROVIDENCE SAINT JOHN'S HEALTH CENTER
Practice address
1339 20TH St
Santa Monica, CA 90404-2033
Phone
(310) 829-8921
Fax
(310) 829-8455
NPI assigned
Feb 23, 2007
Organization subpart
Yes
Parent organization
PROVIDENCE SAINT JOHN'S HOSPITAL AND HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Mrs. Ruth Canas, LCSW
Title
Outpatient Director
Phone
(310) 829-8921

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 569538 CA Primary

Addresses

Primary practice location

1339 20TH St
Santa Monica, CA 90404-2033

Mailing address

1339 20TH St
Santa Monica, CA 90404-2033
Phone (310) 829-8921

Other identifiers 1

IdentifierTypeStateIssuer
000006773MedicaidCA

Other names 1

  • Providence Saint Johns Health COP Other name

National Provider Directory

National Provider Directory
Tax ID family
Providence Saint John'S Health Center4 organizations share this tax ID, including this one
Part of
Providence Saint John'S Health Center

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1609901016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 20TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042033",
            "telephone_number": "310-829-8921",
            "fax_number": "310-829-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 20TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042033",
            "telephone_number": "310-829-8921",
            "fax_number": "310-829-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SAINT JOHN'S HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE SAINT JOHN'S HOSPITAL AND HEALTH CENTER",
        "enumeration_date": "2007-02-23",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "CANAS",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "OUTPATIENT DIRECTOR",
        "authorized_official_telephone_number": "310-829-8921",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "569538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000006773",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Saint Johns Health COP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2016; 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.