Healthcare Provider Details

I. General information

NPI: 1730330838
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES-WA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 PACIFIC AVE
EVERETT WA
98201-4147
US

IV. Provider business mailing address

PO BOX 3369
PORTLAND OR
97208-3369
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-7304
  • Fax: 425-258-7136
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASST SECRETARY-ENROLLMENT
Credential:
Phone: 425-358-9786