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Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Other names
PROVIDENCE LITTLE COMPANY OF MARY HOME HEALTH, POVIDENCE HOME HEALTH LA COUNTY SOUTH
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
5315 TORRANCE BLVD, STE B-169, TORRANCE, CA 90503-4011
(310) 543-3450
(310) 316-2359
Mailing address
PO BOX 31001-3017, PASADENA, CA 91110-3017
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
557447
BLUE CROSS PROV#
CA
01
—
ZZZ66009Z
BLUE SHIELD PROV #
CA
Enumeration date
07/28/2006
Last updated
05/09/2025
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