PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA (NPI# 1700808383) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700808383 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Other Organization Name | PROVIDENCE SAINT JOSEPH MEDICAL CENTER |
| Practice Address |
501 S Buena Vista St Burbank CA 91505-4809 |
| Mailing Address |
Po Box 30027 Los Angeles CA 90030-0027 |
| Practice Telephone | 8188473022 |
| Practice Fax Number | 3103037575 |
| Mailing Telephone | 3103037143 |
| Mailing Fax Number | 3103037575 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2013-05-23 |
| Authorized Official Name | MR. GLENN BALES (CFO) |
| Authorized Official Telephone | 8188473022 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE CROSS PROV# | 555046 | 01 |
| CA | BLUE SHIELD PROV# | ZZZA1901Z | 01 |
| AR | LTC70031F | 05 | |
| CA | LTC55046F | 05 |
| Other Name | Type Code |
|---|---|
| Providence Saint Joseph Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497241541 | Providence Health System - Southern California | Community/Behavioral Health | 1386 W 7th St # A, San Pedro, CA 90732-3517 | 2018-07-02 |
| 1477647444 | Providence Health System - Southern California | Skilled Nursing Facility | 10425 Magnolia Blvd, North Hollywood, CA 91601-4109 | 2006-10-03 |
| 1770639809 | Providence Health System - Southern California | Skilled Nursing Facility | 1322 W 6th St, San Pedro, CA 90732-3501 | 2007-01-25 |
| 1821019514 | Providence Health System - Southern California | Rehabilitation Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-21 |
| 1902824758 | Providence Health System - Southern California | Rehabilitation Unit | 15031 Rinaldi St, Mission Hills, CA 91345-1207 | 2006-07-18 |
| 1669490819 | Providence Health System - Southern California | Rehabilitation Unit | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-17 |
| 1154349371 | Providence Health System - Southern California | Psychiatric Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-17 |
| 1750309837 | Providence Health System - Southern California | Skilled Nursing Facility | 11600 Indian Hills Rd, Building A, Mission Hills, CA 91345-1225 | 2006-07-17 |
| 1477587632 | Providence Health System - Southern California | General Acute Care Hospital | 15031 Rinaldi St, Mission Hills, CA 91345 | 2006-07-11 |
| 1336173269 | Providence Health System - Southern California | General Acute Care Hospital | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-10 |
| Street Address |
501 S BUENA VISTA ST |
| City | BURBANK |
| State | CA |
| Zip Code | 91505-4809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154315604 | Karen A Ellis | Pathology | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2005-09-09 |
| 1235756321 | James Patrick Heath Murphy | Nurse Practitioner | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2020-07-06 |
| 1891319406 | Marie Sol Masigan | Registered Nurse | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2020-05-31 |
| 1669091971 | Jenny C Wong | Pharmacist | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2020-04-16 |
| 1548895253 | Nicholas Bobolia IIi | Registered Nurse | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2020-03-03 |
| 1689208514 | Scott Park | Registered Nurse | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2020-02-29 |
| 1457902645 | Carina Alayne Hornbrook | Physician Assistant | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2019-09-27 |
| 1801443189 | Hanna Amanuel | Social Worker | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2019-08-21 |
| 1558916106 | Yasamin Banihashemi | Nurse Practitioner | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2019-08-09 |
| 1073168282 | Jenny Lin | Physician Assistant | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2019-08-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023625035 | K and S Hospice Inc | Hospice Care, Community Based | 4100 W Alameda Ave Fl 3, Burbank, CA 91505 | 2020-09-24 |
| 1013542471 | Jami Stehlin | Nurse Practitioner | 501 S. Buena Vista St. 3ne, Burbank, CA 91505 | 2020-03-06 |
| 1497309033 | Ibrahim Lala | Pharmacist | 181 S. Buena Vista St, Burbank, CA 91505 | 2019-08-01 |
| 1720501240 | Jung H Li | Registered Nurse | Psjmc- Bariatric Wellness Center, 501 S Buena Vista St, Burbank, CA 91505 | 2017-07-18 |
| 1699204974 | Beth Ellen Izbotsky | Physical Medicine & Rehabilitation | 501 S Buena Vista Blvd, Burbank, CA 91505 | 2017-06-08 |
| 1205387446 | Fabiola Bachman | Dentist | 138 N Pass Ave, 2, Burbank, CA 91505 | 2016-10-24 |
| 1114478203 | Marianna Ghularyan D.d.s. Inc | Dentist | 1400 N. Edison Blvd., Burbank, CA 91505 | 2016-10-24 |
| 1962952127 | Landa Mizin Dental Partnership | Dentist | 2625 W Alameda Ave Ste 502, Burbank, CA 91505 | 2016-10-11 |
| 1285183376 | Amy Di Francia | Marriage & Family Therapist | 4421 W Riverside Dr Ste 210, Burbank, CA 91505 | 2016-09-29 |
| 1306238381 | Abigail Merrin | Physical Therapist | 2701 W Alameda Ave Ste 206, Burbank, CA 91505 | 2015-02-26 |
| Find all providers in zip 91505 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | 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 reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932744349 | Brighter Day Healthcare | Skilled Nursing Facility | 1911 N Kenwood St, Burbank, CA 91505-1420 | 2019-11-08 |
| 1881076990 | Paragon Congregate Living, Inc. | Skilled Nursing Facility | 834 E Elmwood Ave, Burbank, CA 91501-1530 | 2015-06-25 |
| 1467689976 | Burbank Parke Care Center, Inc. | Skilled Nursing Facility | 14976 Burbank Rd, Burbank, OH 44214-9763 | 2009-06-11 |
| 1316019482 | Artesia Healthcare, Inc | Skilled Nursing Facility | 925 W Alameda Avenue, Alameda Care Center, Burbank, CA 91506-2801 | 2006-11-14 |
| 1124048509 | Thi of Illinois At Brentwood, LLC | Skilled Nursing Facility | 5400 W 87th St, Burbank, IL 60459-2913 | 2006-07-20 |
| 1013937309 | Thi of Illinois At Exceptional Health, LLC | Skilled Nursing Facility | 5701 W 79th St, Burbank, IL 60459-1332 | 2006-07-20 |
| 1871057760 | Burbank Rehabilitation Center, LLC | Skilled Nursing Facility | 5400 W 87th St, Burbank, IL 60459-2913 | 2019-01-25 |
| 1902343726 | Veracare Brentwood, LLC | Skilled Nursing Facility | 5400 W 87th St, Burbank, IL 60459-2913 | 2017-01-31 |
| 1720416787 | Brentwood Operating Company LLC | Skilled Nursing Facility | 5400 W 87th St, Burbank, IL 60459-2913 | 2013-10-29 |
| 1780927996 | Rehabcare Group East, Inc. | Skilled Nursing Facility | 5400 W 87th St, Burbank, IL 60459-2913 | 2013-04-05 |
| Find all providers in BURBANK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.