Provider Demographics
NPI:1093056632
Name:PROVIDENCE HEALTH & SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH PROMOTER
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-847-3909
Mailing Address - Street 1:501 S BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4809
Mailing Address - Country:US
Mailing Address - Phone:818-847-3909
Mailing Address - Fax:818-847-3923
Practice Address - Street 1:6801 COLDWATER CANYON AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5162
Practice Address - Country:US
Practice Address - Phone:818-847-3909
Practice Address - Fax:818-847-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital