NPIMap

Organization Active NPI

Providence Health System - Southern California

Doing business as Providence Home Health la County North

  • Home Health Agency
  • Burbank, CA
National Provider Identifier
1164429684
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
980000499 Issued in CA
Legal business name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
Providence Home Health la County North
Providence Home Care
Practice address
250 E Olive Ave Ste 202
Burbank, CA 91502-1211
Phone
(818) 953-4451
Fax
(747) 229-2365
NPI assigned
Jun 30, 2005
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 980000499 CA Primary

Addresses

Primary practice location

250 E Olive Ave Ste 202
Burbank, CA 91502-1211

Mailing address

250 E Olive Ave Ste 202
Burbank, CA 91502-1211
Phone (818) 953-4451

Other names 2

  • PROVIDENCE HOME HEALTH LA COUNTY NORTH Doing business as
  • Providence Home Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070202000134 CA Part A Provider - Home Health Agency 0749190759 Practice locations: Burbank, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164429684. Details of each certification follow.

Home health agency certification: CCN 057627

Legal name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
PROVIDENCE HOME HEALTH LA COUNTY NORTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 30, 1984
Last certification
Jun 14, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1903 in CA
Enrollment address
250 E Olive Ave
Ste 202
Burbank, CA 91502-1211
HHA Branch

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Providence Home Health la County NorthCCN 057627 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
Jan 30, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0920807Providence Health System - Southern California Dba250 E Olive Ave Ste 202, Burbank, CA 91502Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Providence Health System - Southern California5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

201 S Buena Vista St
Ste 125
Burbank, CA 91505
Phone (818) 847-4913

3413 W Pacific Ave
Ste 201
Burbank, CA 91505
Phone (818) 953-4451

503 S Buena Vista St
Ste 102
Burbank, CA 91505
Phone (818) 953-4430

Ownership & related parties

All disclosed owners & managing parties 25

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Diane L Hejna Individual Corporate Director Jul 1, 2016
Richard S Blair Individual Corporate Director Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Terri P Warren Individual W-2 Managing EmployeeVP/Chief Community Services Nov 1, 2022
Carol Elizabeth Pacini Individual Corporate DirectorBoard Member Jan 1, 2021
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Sep 8, 2011
Providence Health System-Southern California Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 100%
Erik Wexler Individual Corporate OfficerPresident Jan 1, 2023
Mary E Lyons Individual Corporate Director Jul 1, 2016
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Phyllis M Hughes Individual Corporate Director Jul 1, 2016
James Martin Individual Corporate OfficerAsst Treasurer Jan 13, 2023
Malisa J Westlund Individual W-2 Managing EmployeeFinancial Executive Mar 6, 2021
Charles Wallace Sorenson Individual Corporate DirectorBoard of Directors Jan 1, 2019
Michael D Robinson Individual Operational/Managerial ControlChief, Home Health Jan 1, 2021
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary for Enrollment Dec 20, 2016
Gregory David Hoffman Individual Corporate OfficerEvp/Cfo Oct 1, 2020
Isiaah D Crawford Individual Corporate Director Jul 1, 2016
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorDirector Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorBoard Member Sep 1, 2022
Eric D Sprunk Individual Corporate DirectorDirector Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Facilities with the same owner 140

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 140

Practitioners & affiliated clinicians

Affiliated clinicians 16

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1164429684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E OLIVE AVE STE 202",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021211",
            "telephone_number": "818-953-4451",
            "fax_number": "747-229-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E OLIVE AVE STE 202",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021211",
            "telephone_number": "818-953-4451",
            "fax_number": "747-229-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "980000499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE HOME HEALTH LA COUNTY NORTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.