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General NPI Number Information
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NPI Number | 1205931508
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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 | 09/13/2006
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 18313 PAULSON ST SW SUITE A
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City | ROCHESTER
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State | WA
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Zip | 98579-9262
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Country | US
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Telephone | 360-827-8400
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Fax | 360-273-7301
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4114
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City | PASADENA
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State | CA
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Zip | 91110-4114
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Country | US
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Telephone | 503-893-7120
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Fax | 425-276-3215
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Authorized Official
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Title or Position | ASST CORP SEC FOR ENROLLMENTS
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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 | 174400000X
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Taxonomy Name | Specialist
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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