MEDICARE: PROVIDENCE HEALTH & SERVICES - WASHINGTON

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	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689827321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES - WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 94511
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-6811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 S 102ND ST
Second Line	:	SUITE 220
City	:	SEATTLE
State	:	WA
Zip	:	98168-1870
Country	:	US
Telephone Number	:	206-320-4000
Fax Number	:	206-320-2280

Authorized Official
Title or Position	:	ASSISTANT SECRETARY ENROLLMENT
Name	:	DONALD W ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	05/16/2025

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