MEDICARE: FAIRFAX HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit	RC00053238	WA
2	221700000X	Art Therapist	05-019	NC

General Provider Information

NPI Number	:	1588702526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRFAX HOSPITAL INC

Provider Business Mailing Address
First Line	:	1729 12TH AVE APT 110
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-2492
Country	:	US
Telephone Number	:	206-783-6850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 12TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-2435
Country	:	US
Telephone Number	:	206-375-5872
Fax Number	:

Authorized Official
Title or Position	:	ART THERAPIST
Name	:	JOANNE MARIE DELLA PENTA
Credential	:	ART-BC, LMHC
Telephone Number	:	425-821-2000

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/11/2025

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