Healthcare Provider Details

I. General information

NPI: 1588702526
Provider Name (Legal Business Name): FAIRFAX HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 12TH AVE
SEATTLE WA
98122-2435
US

IV. Provider business mailing address

1729 12TH AVE APT 110
SEATTLE WA
98122-2492
US

V. Phone/Fax

Practice location:
  • Phone: 206-375-5872
  • Fax:
Mailing address:
  • Phone: 206-783-6850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberRC00053238
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05-019
License Number StateNC

VIII. Authorized Official

Name: JOANNE MARIE DELLA PENTA
Title or Position: ART THERAPIST
Credential: ART-BC, LMHC
Phone: 425-821-2000