Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Parent organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 832-3311
Mailing address
PO BOX 31001-3017, PASADENA, CA 91110-3017
(310) 303-7496
(310) 303-7496
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05S078
BLUE CROSS
CA
05
—
HSM30078G
—
CA
Enumeration date
07/17/2006
Last updated
05/08/2025
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