Healthcare Provider Details

I. General information

NPI: 1326033184
Provider Name (Legal Business Name): LITTLE COMPANY OF MARY SUBACUTE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 LOMITA BLVD
TORRANCE CA
90505-3938
US

IV. Provider business mailing address

3620 LOMITA BLVD
TORRANCE CA
90505-3938
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-4511
  • Fax: 310-791-4512
Mailing address:
  • Phone: 310-791-4511
  • Fax: 310-791-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberHSP37720
License Number StateCA

VIII. Authorized Official

Name: DR. ROGER W GREENHAM
Title or Position: PHARMACIST IN CHARGE/MANAGER
Credential: PHARM D
Phone: 310-791-4511