Provider Demographics
NPI:1104206176
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:USC VERDUGO HILLS HOSPITAL SNF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-442-9775
Mailing Address - Street 1:1510 SAN PABLO ST
Mailing Address - Street 2:HCC 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5320
Mailing Address - Country:US
Mailing Address - Phone:323-442-9775
Mailing Address - Fax:323-442-9848
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:HCC 600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-9775
Practice Address - Fax:323-442-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility