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General NPI Number Information
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NPI Number | 1407945389
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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 | 10/11/2006
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 3760 PIPER ST SUITE LL 139
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City | ANCHORAGE
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State | AK
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Zip | 99508-4665
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Country | US
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Telephone | 907-563-5006
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Fax | 907-563-3217
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Provider Business Mailing Address
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Address Line | PO BOX 4105
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City | PORTLAND
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State | OR
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Zip | 97208-4105
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Country | US
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Telephone | 866-907-1068
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Fax | 425-917-9141
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF 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 | 2084P0800X
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Taxonomy Name | Psychiatry 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 | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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 | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 512146
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License Number State | AK
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | NOT NUMBERED
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License Number State | AK
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