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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