| Providence Mission Hospital | |
|
31872 Coast Hwy Laguna Beach CA 92651-6773 | |
| (949) 364-1400 | |
| Not Available |
| Full Name | Providence Mission Hospital |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 31872 Coast Hwy, Laguna Beach, California |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT SECRETARY FOR ENROLLMENT) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Mission Hospital 31872 Coast Hwy Laguna Beach CA 92651-6773 Ph: (949) 364-1400 | Providence Mission Hospital 31872 Coast Hwy Laguna Beach CA 92651-6773 Ph: (949) 364-1400 |
| NPI Number | 1093945412 |
|---|---|
| Provider Enumeration Date | 07/20/2009 |
| Last Update Date | 03/18/2021 |
| Certification Date | 03/18/2021 |
| Medicare PECOS PAC ID | 7416045893 |
|---|---|
| Medicare Enrollment ID | O20090717000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093945412 | NPI | - | NPPES |
| 05S567 | Other | CA | MEDICARE PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 060000146 (California) | Primary |
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