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General NPI Number Information
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NPI Number | 1992704126
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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 | 07/19/2005
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 3333 ENSIGN RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5012
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Country | US
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Telephone | 360-493-4900
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Fax | 360-493-4000
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Provider Business Mailing Address
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Address Line | 3333 ENSIGN RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5012
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Country | US
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Telephone | 360-493-4900
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Fax | 360-493-4000
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Authorized Official
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Title or Position | ASST SECRETARY 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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH1067
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License Number State | WA
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