Healthcare Provider Details

I. General information

NPI: 1992743561
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST SUITE 101
ANCHORAGE AK
99508-5428
US

IV. Provider business mailing address

3760 PIPER ST SUITE 1061
ANCHORAGE AK
99508-4665
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-4400
  • Fax: 907-212-4401
Mailing address:
  • Phone: 907-212-0256
  • Fax: 907-212-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786