Healthcare Provider Details

I. General information

NPI: 1821240425
Provider Name (Legal Business Name): PROVIDENCE HEALTH & SERVICES - WA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6018 N ASTOR ST
SPOKANE WA
99208-1107
US

IV. Provider business mailing address

6018 N ASTOR ST
SPOKANE WA
99208-1107
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-2475
  • Fax: 509-482-2490
Mailing address:
  • Phone: 509-482-2475
  • Fax: 509-482-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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