# PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Holy Cross Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750309837
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 11600 INDIAN HILLS RD, BUILDING A, MISSION HILLS, CA 91345-1225
- **Practice address phone:** (818) 365-8051
- **Practice address fax:** (818) 496-4569
- **Mailing address:** PO BOX 31001-3017, PASADENA, CA 91110-3017

## Taxonomy

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

## Other

- **Enumeration date:** 07/17/2006
- **Last updated:** 05/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 555074 | BLUE CROSS PROV\# | CA |
| 05 | — | LTC70041G | — | CA |
| 05 | — | ZZT18872G | — | CA |
| 01 | — | ZZZA1901Z | BLUE SHIELD PROV\# | AR |