# PROVIDENCE FACEY MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FACEY MEDICAL FOUNDATION
- **Other names:** FACEY ENDOSCOPY CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194083824
- **Legal business name:** FACEY MEDICAL FOUNDATION
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 11333 SEPULVEDA BLVD, SUITE 3200, MISSION HILLS, CA 91345-1116
- **Practice address phone:** (818) 837-5776
- **Practice address fax:** (818) 837-5810
- **Mailing address:** FILE 50670, LOS ANGELES, CA 90074-0670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/01/2012
- **Last updated:** 05/06/2025