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General NPI Number Information
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NPI Number | 1598750895
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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 | 09/13/2005
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 3725 PROVIDENCE POINT DR SE
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City | ISSAQUAH
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State | WA
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Zip | 98029-7219
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Country | US
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Telephone | 425-391-2800
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Fax | 425-391-5440
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Provider Business Mailing Address
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Address Line | PO BOX 94582
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City | SEATTLE
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State | WA
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Zip | 98124-6882
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Country | US
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Telephone | 425-391-2800
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Fax | 425-391-5440
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1177
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License Number State | WA
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