# PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Little Company of Mary Transitional Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952348518
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 4320 MARICOPA ST, TORRANCE, CA 90503-4314
- **Practice address phone:** (310) 303-7496
- **Practice address fax:** (310) 303-7575
- **Mailing address:** PO BOX 31001-3017, PASADENA, CA 91110-3017

## Taxonomy

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

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 05/09/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 056499 | BLUE CROSS PROVIDER NUMBE | CA |
| 05 | — | LTC06499F | — | CA |
| 01 | — | ZZZM1976B | BLUE SHIELD PROVIDER NUMB | CA |