Organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Active
Other names
Providence Little Company of Mary Sub Acute 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
1322 W 6TH ST, SAN PEDRO, CA 90732-3501
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555848
BLUE CROSS
CA
Enumeration date
01/25/2007
Last updated
05/09/2025
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