Provider Demographics
NPI:1033114582
Name:LITTLE COMPANY OF MARY HEALTH SERVICES
Entity Type:Organization
Organization Name:LITTLE COMPANY OF MARY HEALTH SERVICES
Other - Org Name:LITTLE COMPANY OF MARY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUANICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-303-7496
Mailing Address - Street 1:PO BOX 6668
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90734-6668
Mailing Address - Country:US
Mailing Address - Phone:310-303-7496
Mailing Address - Fax:310-303-7575
Practice Address - Street 1:3551 VOYAGER ST
Practice Address - Street 2:STE 201
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1674
Practice Address - Country:US
Practice Address - Phone:310-303-7496
Practice Address - Fax:310-303-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000818251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66009ZOtherBLUE SHIELD PROV#
CAHHA57447GMedicaid
CA557447OtherBLUE CROSS PROV#
CA557447Medicare ID - Type UnspecifiedMEDICARE PROV #