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DSH050353A PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE (Active)
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Main Details
Name
PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE
Subdivision Name
OUTPATIENT REHABILITATION / Physical Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050353A
Medicare Provider Number
050353
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/26/2016
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Providence Health & Services Little Company of Mary Medical Centers San Pedro and Torrance
John Fleming Goeders, Chief Financial Officer
(310) 829-8411
Primary Contact
Providence Little Company of Mary Medical Center
Muno Bholat, Director of Pharmacy
(310) 303-5722
Addresses
Street Address
21135 HAWTHORNE BLVD
TORRANCE, CA 90503-4615
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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