Organization · Type 2 NPI

Providence Health System - Southern California

Skilled Nursing Facility · San Pedro, CA

NPI number 1770639809 Active

Practice location

1322 W 6th St
San Pedro, CA 90732-3501

Call (310) 303-7496 Map

Fax (310) 303-7575

Mailing address

PO Box 31001-3017
Pasadena, CA 91110-3017

Specialties and licenses

Taxonomy	Code	License
Skilled Nursing Facility Primary	314000000X	None listed

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 r…

Another provider at this address

San Pedro Peninsula HospitalSkilled Nursing Facility San Pedro, CA NPI 1750305116

Other skilled nursing facility providers in San Pedro

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NPI record

NPI: 1770639809
Entity type: Organization (Type 2)
Issued: Jan 25, 2007
Last updated: May 9, 2025
Status: Active

Other names

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Providence Little Company of Mary Sub Acute Care Center · doing business as
Providence Little Company of Mary Sub Acute Care Center · doing business as

Authorized official

Donald W Anderson
Assistant Secretary Enrollments
(425) 358-9786

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1770639809

Providence Health System - Southern California's National Provider Identifier is 1770639809, issued on Jan 25, 2007. The primary taxonomy on file is Skilled Nursing Facility (314000000X), and the practice location is in San Pedro, CA. The record was last updated on May 9, 2025.