Healthcare Provider Details

I. General information

NPI: 1952386369
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 35TH AVE SW
SEATTLE WA
98126-2709
US

IV. Provider business mailing address

4831 35TH AVE SW
SEATTLE WA
98126-2709
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-3700
  • Fax: 206-938-8999
Mailing address:
  • Phone: 206-937-3700
  • Fax: 206-938-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberBH-198
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number77
License Number StateWA

VIII. Authorized Official

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