# PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORINA
- **Other names:** Providence Little Company of Mary Medical Center San Pedro OBHC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497241541
- **Legal business name:** PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORINA
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1386 W 7TH ST \# A, SAN PEDRO, CA 90732-3517
- **Practice address phone:** (310) 241-4330
- **Practice address fax:** (310) 241-4342
- **Mailing address:** PO BOX 541024, LOS ANGELES, CA 90054-1024
- **Mailing address phone:** (310) 303-7496
- **Mailing address fax:** (310) 303-7575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 282N00000X | General Acute Care Hospital | 930000142 | CA | Yes |

## Other

- **Enumeration date:** 07/02/2018
- **Last updated:** 05/09/2025