# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE HOSPICE & HOME CARE OF SNOHOMISH COUNTY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053027102
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASST. SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 525-5392

## Contact information

- **Practice address:** 1615 75TH ST SW STE 210, EVERETT, WA 98203-6293
- **Practice address phone:** (425) 261-4800
- **Mailing address:** PO BOX 94502, SEATTLE, WA 98124-6802
- **Mailing address phone:** (425) 261-4800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | — | Yes |
| 2080H0002X | Pediatric Hospice and Palliative Medicine Physician | — | NULL | — |
| 2080H0002X | Pediatric Hospice and Palliative Medicine Physician | — | — | — |
| 251G00000X | Community Based Hospice Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 01/23/2023
- **Last updated:** 01/25/2023