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General NPI Number Information
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NPI Number | 1083947709
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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 | 09/14/2009
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1615 75TH ST SW STE 210
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City | EVERETT
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State | WA
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Zip | 98203-6293
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Country | US
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Telephone | 425-261-4800
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Fax | 425-261-4868
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Provider Business Mailing Address
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Address Line | 1615 75TH ST SW STE 210
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City | EVERETT
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State | WA
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Zip | 98203-6293
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Country | US
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Telephone | 425-261-4800
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Fax | 425-261-4868
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Authorized Official
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Title or Position | ASSISTANT SECRETARY 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 | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | IHS.FS.00000418
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License Number State | WA
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