Healthcare Provider Details

I. General information

NPI: 1992882534
Provider Name (Legal Business Name): LITTLE SISTERS OF THE POOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S WESTERN AVE
SAN PEDRO CA
90732-4331
US

IV. Provider business mailing address

2100 S WESTERN AVE
SAN PEDRO CA
90732-4331
US

V. Phone/Fax

Practice location:
  • Phone: 310-548-0625
  • Fax: 310-831-6751
Mailing address:
  • Phone: 310-548-0625
  • Fax: 310-831-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: SISTER MARGUERITE MCCARTHY III
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-548-0625