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Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Other names
Providence St. Elizabeth Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
10425 MAGNOLIA BLVD, NORTH HOLLYWOOD, CA 91601-4109
(818) 980-3872
Mailing address
10425 MAGNOLIA BLVD, NORTH HOLLYWOOD, CA 91601-4109
(818) 980-3872
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
920000070
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05192H
—
CA
Enumeration date
10/03/2006
Last updated
05/16/2025
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