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General NPI Number Information
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NPI Number | 1508058520
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH SYSTEM WASHINGTON
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 914 S SCHEUBER RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9027
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Country | US
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Telephone | 360-736-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 914 S SCHEUBER RD
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City | CENTRALIA
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State | WA
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Zip | 98531-9027
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Country | US
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Telephone | 360-736-2803
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Fax |
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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 | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 602399531
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License Number State | WA
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