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General NPI Number Information
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NPI Number | 1033106687
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 914 S SCHEUBER RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9027
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Country | US
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Telephone | 360-330-8703
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Fax | 360-330-8706
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Provider Business Mailing Address
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Address Line | PO BOX 34439 PBO/CREDENTIALING
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City | SEATTLE
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State | WA
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Zip | 98124-1439
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Country | US
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Telephone | 425-525-6778
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Fax | 425-525-6700
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Authorized Official
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Title or Position | ASSISTANT SECRETARY FOR ENROLLMENT
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 4211918
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License Number State | WA
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