Healthcare Provider Details

I. General information

NPI: 1164532172
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST SUITE 101
ANCHORAGE AK
99508-5428
US

IV. Provider business mailing address

4001 DALE ST STE 101
ANCHORAGE AK
99508-5444
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-0130
  • Fax: 907-563-0135
Mailing address:
  • Phone: 907-563-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateAK

VIII. Authorized Official

Name: MR. DONALD W ANDERSON JR.
Title or Position: DIR REIMB REG STRAT/ASST SEC ENROLL
Credential:
Phone: 425-525-5392