PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA (NPI# 1770639809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770639809 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Other Organization Name | PROVIDENCE LITTLE COMPANY OF MARY SUB ACUTE CARE CENTER |
| Practice Address |
1322 W 6th St San Pedro CA 90732-3501 |
| Mailing Address |
Po Box 6668 San Pedro CA 90734-6668 |
| Practice Telephone | 3103037496 |
| Practice Fax Number | 3103037575 |
| Mailing Telephone | 3103037496 |
| Mailing Fax Number | 3103037575 |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2013-05-23 |
| Authorized Official Name | MRS. ELIZABETH ZUANICH (CFO) |
| Authorized Official Telephone | 3103037496 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE CROSS | 555848 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Little Company of Mary Sub Acute Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497241541 | Providence Health System - Southern California | Community/Behavioral Health | 1386 W 7th St # A, San Pedro, CA 90732-3517 | 2018-07-02 |
| 1477647444 | Providence Health System - Southern California | Skilled Nursing Facility | 10425 Magnolia Blvd, North Hollywood, CA 91601-4109 | 2006-10-03 |
| 1700808383 | Providence Health System - Southern California | Skilled Nursing Facility | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-24 |
| 1821019514 | Providence Health System - Southern California | Rehabilitation Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-21 |
| 1902824758 | Providence Health System - Southern California | Rehabilitation Unit | 15031 Rinaldi St, Mission Hills, CA 91345-1207 | 2006-07-18 |
| 1669490819 | Providence Health System - Southern California | Rehabilitation Unit | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-17 |
| 1154349371 | Providence Health System - Southern California | Psychiatric Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-17 |
| 1750309837 | Providence Health System - Southern California | Skilled Nursing Facility | 11600 Indian Hills Rd, Building A, Mission Hills, CA 91345-1225 | 2006-07-17 |
| 1477587632 | Providence Health System - Southern California | General Acute Care Hospital | 15031 Rinaldi St, Mission Hills, CA 91345 | 2006-07-11 |
| 1336173269 | Providence Health System - Southern California | General Acute Care Hospital | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-10 |
| Street Address |
1322 W 6TH ST |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90732-3501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750305116 | San Pedro Peninsula Hospital | Skilled Nursing Facility | 1322 W 6th St, San Pedro, CA 90732-3501 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771241 | Alicia Avila | Student in an Organized Health Care Education/Training Program | 2227 Blue Butterfly Way, #7, San Pedro, CA 90732 | 2020-08-24 |
| 1619500543 | Udana Harris | Registered Nurse | 1300 West 7th Street, Obhc Unit, San Pedro, CA 90732 | 2020-02-19 |
| 1861042301 | Patricia Elaine Moses | Technician | 106 N. Western Ave Unit 102, San Pedro, CA 90732 | 2019-09-17 |
| 1629627393 | Antonio Ramon Martinez | Technician | 3141 Blue Butterfly Unit 66, San Pedro, CA 90732 | 2019-09-05 |
| 1487207700 | Victoria A. Shook, D.d.s., A Professional Corp. | Dentist | 28138 S. Western Ave., San Pedro, CA 90732 | 2019-07-17 |
| 1144566563 | Shaun E Chandran M D Inc | Orthopaedic Surgery | 1360 W 6th Street, Suite 305, San Pedro, CA 90732 | 2012-12-13 |
| 1316281280 | Jenny Luong | Physician Assistant | 1534 W. 25th St, San Pedro, CA 90732 | 2012-11-16 |
| 1033429519 | Eric M Feit Dpm Inc | Podiatrist | 1360 West 6th St., Suite 240, San Pedro, CA 90732 | 2010-10-18 |
| 1386808673 | Meysam Zaker | Dentist | 2470 S. Western Ave, San Pedro, Ca, CA 90732 | 2008-07-15 |
| 1376735340 | Francisco J. Correa, M.d., Inc | General Practice | 1350 W. 6th St, #3, San Pedro, CA 90732 | 2007-08-14 |
| Find all providers in zip 90732 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629146097 | Seacrest Convalescent Hospital, Inc. | Skilled Nursing Facility | 1416 W 6th St, San Pedro, CA 90732-3503 | 2006-12-01 |
| 1306914775 | San Pedro Convalescent Home, Inc. | Skilled Nursing Facility | 1430 W 6th St, San Pedro, CA 90732-3503 | 2006-12-01 |
| 1992882534 | Little Sisters of The Poor | Skilled Nursing Facility | 2100 S Western Ave, San Pedro, CA 90732-4331 | 2006-11-01 |
| 1750305116 | San Pedro Peninsula Hospital | Skilled Nursing Facility | 1322 W 6th St, San Pedro, CA 90732-3501 | 2006-07-27 |
| 1316989791 | Little Company of Mary - San Pedro | Skilled Nursing Facility | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073114807 | The Healing Sanctum-greenmeadow, LLC | Skilled Nursing Facility | 5302 E Greenmeadow Rd, Long Beach, CA 90808-1620 | 2020-11-06 |
| 1528667581 | Winterfest Medical Services Corporation | Skilled Nursing Facility | 8758 Winterfest Way, Elk Grove, CA 95624-1295 | 2020-10-21 |
| 1689272528 | Orchards Hc LLC | Skilled Nursing Facility | 1 Amistad Drive, Rancho Mission Viejo, CA 92694 | 2020-10-13 |
| 1083223481 | Santa Clarita Congregate Living Inc | Skilled Nursing Facility | 29830 Wisteria Valley Rd, Santa Clarita, CA 91387-1954 | 2020-07-31 |
| 1033737051 | Beautiful Homes Residential Care Inc | Skilled Nursing Facility | 22525 Cerise Ave, Torrance, CA 90505-2913 | 2020-07-07 |
| 1043837966 | Desert Ridge Transitional Care Center, Lp | Skilled Nursing Facility | 13300 11th Avenue, Victorville, CA 92395 | 2020-06-26 |
| 1881210847 | Ghc of Tem - Snf, LLC | Skilled Nursing Facility | 44320 Campanula Way, Temecula, CA 92592-7903 | 2020-06-24 |
| 1861018327 | Covina Clhf Corporation | Skilled Nursing Facility | 1411 S Sandia Ave, West Covina, CA 91790-3309 | 2020-06-22 |
| 1780204024 | Neighbor Care Congregate Home, Inc. | Skilled Nursing Facility | 3249 Gerald Dr, Newbury Park, CA 91320-2948 | 2020-04-16 |
| 1558998047 | Sunflower Clhf, Inc. | Skilled Nursing Facility | 1058 Ruberta Ave, Glendale, CA 91201-2105 | 2020-03-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.