Healthcare Provider Details

I. General information

NPI: 1174774673
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 8TH AVE
SPOKANE WA
99202-1201
US

IV. Provider business mailing address

PO BOX 94582
SEATTLE WA
98124-6882
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-5678
  • Fax: 509-624-1095
Mailing address:
  • Phone: 509-474-5678
  • Fax: 509-624-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateWA

VIII. Authorized Official

Name: DONALD W ANDERSON JR.
Title or Position: DIR REIMB REG STRAT/ASST SEC ENROLL
Credential:
Phone: 425-525-5392