Organization
ST. JOSEPH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VA LECIA ADAMS KELLUM PH.D. (EXECUTIVE DIRECTOR)
(310) 396-6468
Entity
Organization
Contact information
Practice address
204 HAMPTON DR, VENICE, CA 90291-2623
(310) 396-6468
(310) 392-8402
Mailing address
204 HAMPTON DR, VENICE, CA 90291-2623
(310) 396-6468
(310) 392-8402
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7114
—
CA
Enumeration date
03/01/2007
Last updated
02/03/2015
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