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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 Transitional Care Center
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
4320 MARICOPA ST, TORRANCE, CA 90503-4314
(310) 303-7496
(310) 303-7575
Mailing address
PO BOX 31001-3017, PASADENA, CA 91110-3017
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056499
BLUE CROSS PROVIDER NUMBE
CA
05
—
LTC06499F
—
CA
01
—
ZZZM1976B
BLUE SHIELD PROVIDER NUMB
CA
Enumeration date
06/01/2006
Last updated
05/09/2025
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