Healthcare Provider Details

I. General information

NPI: 1508937947
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PROVIDENCE DR
ANCHORAGE AK
99508-4615
US

IV. Provider business mailing address

PO BOX 4048
PORTLAND OR
97208-4048
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2211
  • Fax:
Mailing address:
  • Phone: 907-562-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberNOT NUMBERED
License Number StateAK

VIII. Authorized Official

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