Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Other names
Providence Holy Cross Medical 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
11600 INDIAN HILLS RD, BUILDING A, MISSION HILLS, CA 91345-1225
(818) 365-8051
(818) 496-4569
Mailing address
PO BOX 31001-3017, PASADENA, CA 91110-3017
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
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
Enumeration date
07/17/2006
Last updated
05/09/2025
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