Healthcare Provider Details

I. General information

NPI: 1992704126
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 ENSIGN RD NE
OLYMPIA WA
98506-5012
US

IV. Provider business mailing address

3333 ENSIGN RD NE
OLYMPIA WA
98506-5012
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-4900
  • Fax: 360-493-4000
Mailing address:
  • Phone: 360-493-4900
  • Fax: 360-493-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1067
License Number StateWA

VIII. Authorized Official

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