Providence Health System - Southern California
NPI 1770639809 · Skilled Nursing Facility · San Pedro, CA
Enrolled with Medicare as Part a Provider - Skilled Nursing Facility · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Providence Health System - Southern California is a Skilled Nursing Facility organization in San Pedro, CA (NPI 1770639809).
Provider details
- NPI number
- 1770639809
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Donald Anderson, Assistant Secretary Enrollments(425) 358-9786
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Providence Little Company of Mary Sub Acute Care Center
- Doing business as
- Providence Little Company of Mary Sub Acute Care Center
Registry dates
- Enumerated
- 2007-01-25
- Last updated
- 2025-05-09
- Certified
- 2025-05-09
Frequently asked questions
- What is Providence Health System - Southern California's NPI number?
- Providence Health System - Southern California's National Provider Identifier (NPI) is 1770639809, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Providence Health System - Southern California?
- Providence Health System - Southern California is classified in the NPPES registry as Skilled Nursing Facility (Nursing & Custodial Care Facilities).
- Where is Providence Health System - Southern California located?
- Providence Health System - Southern California's practice location on file with NPPES is 1322 W 6th St, San Pedro, CA 90732-3501.
- What is Providence Health System - Southern California's phone number?
- The practice phone number listed in the NPPES registry for Providence Health System - Southern California is (310) 303-7496.
- Does Providence Health System - Southern California accept Medicare?
- Providence Health System - Southern California is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Providence Health System - Southern California?
- The authorized official listed on Providence Health System - Southern California's NPPES record is Donald Anderson, Assistant Secretary Enrollments. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Providence Health System - Southern California's NPI active?
- Yes — Providence Health System - Southern California's NPI (1770639809) is active in the NPPES registry as of the last update on 2025-05-09.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.