Healthcare Provider Details

I. General information

NPI: 1396827424
Provider Name (Legal Business Name): PROVIDENCE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E 1015 'D' STREET
DEER PARK WV
99006-0742
US

IV. Provider business mailing address

E 1015 'D' STREET P O BOX 742
DEER PARK WA
99006-0742
US

V. Phone/Fax

Practice location:
  • Phone: 509-276-5061
  • Fax: 509-276-8713
Mailing address:
  • Phone: 509-276-5061
  • Fax: 509-276-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-178
License Number StateWA

VIII. Authorized Official

Name: MRS. COLLEEN FEBACH
Title or Position: NURSING DIRECTOR
Credential:
Phone: 509-276-3500