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General NPI Number Information
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NPI Number | 1063524346
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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 | 08/31/2006
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2811 S 102ND ST
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City | TUKWILA
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State | WA
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Zip | 98168-1870
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Country | US
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Telephone | 425-525-6800
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Fax | 425-525-6825
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Provider Business Mailing Address
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Address Line | 2811 S 102ND ST
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City | TUKWILA
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State | WA
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Zip | 98168-1870
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Country | US
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Telephone | 425-525-6800
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Fax | 425-525-6825
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENT
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Name | MR. 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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | WA
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