# PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence St. Elizabeth Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477647444
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 10425 MAGNOLIA BLVD, NORTH HOLLYWOOD, CA 91601-4109
- **Practice address phone:** (818) 980-3872
- **Mailing address:** 10425 MAGNOLIA BLVD, NORTH HOLLYWOOD, CA 91601-4109
- **Mailing address phone:** (818) 980-3872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 920000070 | CA | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 05/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT05192H | — | CA |