| Providence Health System - Southern California | |
|
1300 W 7th St San Pedro CA 90732-3505 | |
| (310) 832-3311 | |
| Not Available |
| Full Name | Providence Health System - Southern California |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1300 W 7th St, San Pedro, California |
| Authorized Official Name and Position | Donald Wayne Anderson (ASSISTANT SECRETARY - 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 Health System - Southern California Po Box 2335 Spokane WA 99210-2335 Ph: (310) 303-7496 | Providence Health System - Southern California 1300 W 7th St San Pedro CA 90732-3505 Ph: (310) 832-3311 |
| NPI Number | 1154349371 |
|---|---|
| Provider Enumeration Date | 07/17/2006 |
| Last Update Date | 12/24/2018 |
| Medicare PECOS PAC ID | 0042248536 |
|---|---|
| Medicare Enrollment ID | O20070127000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154349371 | NPI | - | NPPES |
| HSM30078G | Medicaid | CA | |
| 05S078 | Other | CA | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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La County Department Of Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 150 W 7th St, San Pedro, CA 90731 Phone: 310-519-6224 | |
Los Angeles County Department Of Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 330 Ferry St, San Pedro, CA 90731 Phone: 213-947-6271 Fax: 213-351-2490 |