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Organization Active NPI

Providence Health System - Southern California

  • General Acute Care Hospital
  • Mission Hills, CA
National Provider Identifier
1477587632
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Practice address
15031 Rinaldi St
Mission Hills, CA 91345
Phone
(818) 365-8051
Fax
(818) 496-4565
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 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 Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

15031 Rinaldi St
Mission Hills, CA 91345

Mailing address

PO Box 31001-3017
Pasadena, CA 91110-3017
Phone (310) 303-7143

Other identifiers 5

IdentifierTypeStateIssuer
ZZT30278GMedicaidCA
ZZT40278GMedicaidCA
050278OtherCABLUE CROSS PROV#
ZZZD1940ZOtherCABLUE SHIELD PROV#
HSC30278GMedicaidCA

Other names 1

  • Providence Holy Cross Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070116000648 CA Part A Provider - Hospital 1658370911 Practice locations: Mission Hills, CA; Porter Ranch, CA

Hospital certification: CCN 050278

Legal name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
PROVIDENCE HOLY CROSS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 1, 2021
Beds
257
Ownership / control type
Church
Most recent change of ownership
May 1, 1996 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1903 in CA
Enrollment address
15031 Rinaldi St
Mission Hills, CA 91345-1207
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Holy Cross Medical CenterCCN 050278
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Providence Holy Cross M3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations (25 of 44)

191 S Buena Vista St
Ste 100
Burbank, CA 91505
Phone (818) 869-7600

1218 W Olive Ave
Burbank, CA 91506
Phone (818) 842-6429

1000 N Central Ave
Ste 210
Glendale, CA 91202
Phone (818) 325-2088

10316 Woodley Ave
Granada Hills, CA 91344
Phone (818) 368-5651

9834 Genesee Ave
Ste 223B
La Jolla, CA 92037
Phone (582) 777-1238

1127 Wilshire Blvd
Ste 600
Los Angeles, CA 90017
Phone (213) 250-7735

11550 Indian Hills Rd
Ste 381
Mission Hills, CA 91345
Phone (818) 361-5069

11333 Sepulveda Blvd
Fl 3
Mission Hills, CA 91345
Phone (818) 869-7268

14901 Rinaldi St
Ste 330
Mission Hills, CA 91345
Phone (818) 365-7778

14901 Rinaldi St
Mission Hills, CA 91345
Phone (818) 365-7988

15451 San Fernando Mission Blvd
Mission Hills, CA 91345
Phone (818) 837-5554

18460 Roscoe Blvd
Northridge, CA 91325
Phone (818) 734-3600

18915 Nordhoff St
Ste 7
Northridge, CA 91324
Phone (747) 237-7041

8510 Balboa Blvd
Ste 250
Northridge, CA 91325

17075 Devonshire St
Ste 209
Northridge, CA 91325
Phone (818) 832-7802

18546 Roscoe Blvd
Ste 200
Northridge, CA 91324
Phone (818) 993-1112

17075 Devonshire St
Ste 100
Northridge, CA 91325
Phone (800) 673-8185

17075 Devonshire St
Ste 300
Northridge, CA 91325
Phone (818) 368-4212

17075 Devonshire St
Ste 305
Northridge, CA 91325
Phone (818) 363-0110

293 S Main St
Orange, CA 92868
Phone (714) 282-9495

14860 Roscoe Blvd
Ste 300
Panorama City, CA 91402
Phone (818) 392-8620

808 S Fair Oaks Ave
Pasadena, CA 91105
Phone (626) 577-1675

2619 E Colorado Blvd
Pasadena, CA 91107

1403 N Fair Oaks Ave
Ste 3
Pasadena, CA 91103
Phone (626) 394-0354

39 Congress St
Ste 301
Pasadena, CA 91105
Phone (626) 486-0181

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 DirectorDirector Jul 1, 2016
Richard S Blair Individual Corporate DirectorDirector Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Jason Kell Individual W-2 Managing EmployeeFinancial Executive Jan 1, 2026
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Aug 24, 2011
Providence Health System-Southern California Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 24, 2011 100%
Mary E Lyons Individual Corporate DirectorDirector Jul 1, 2016
Phyllis M Hughes Individual Corporate DirectorDirector Jul 1, 2016
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAssistant Treasurer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard of Directors Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Dec 20, 2016
Gregory David Hoffman Individual Corporate OfficerCfo/Treasurer Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorDirector Jul 1, 2016
Bernard Jay Klein Individual W-2 Managing EmployeeChief Executive Feb 1, 2013
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 DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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

Practitioners 501

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 501

Affiliated clinicians 376

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

View all 376

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1477587632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-3017",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911103017",
            "telephone_number": "310-303-7143",
            "fax_number": "310-303-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15031 RINALDI ST",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "91345",
            "telephone_number": "818-365-8051",
            "fax_number": "818-496-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT30278G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT40278G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV#",
            "identifier": "050278",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV#",
            "identifier": "ZZZD1940Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSC30278G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Holy Cross Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Holy Cross Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mission Hills, CA

Sources for this page

Verify at the official NPI Registry.