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General NPI Number Information
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NPI Number | 1043374119
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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 | 12/21/2006
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 508 QUARTER EIGHTH STREET
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City | HOQUIAM
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State | WA
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Zip | 98550
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Country | US
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Telephone | 360-533-8813
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Fax |
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Provider Business Mailing Address
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Address Line | 909 N BROADWAY PBO/CREDENTAILING
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City | EVERETT
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State | WA
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Zip | 98201-1409
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Country | US
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Telephone | 425-317-0246
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Fax | 425-317-0291
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Authorized Official
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Title or Position | ASSISTANT SECREATRY 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 | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number |
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License Number State |
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