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Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence St. Peter Chemical Dependency Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
506 W FRANKLIN ST, SHELTON, WA 98584-3517
(360) 432-8692
Mailing address
909 N BROADWAY, PBO/CREDENTIALING, EVERETT, WA 98201-1409
(425) 317-0246
(425) 317-0291
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary
—
NULL
Other
Enumeration date
12/20/2006
Last updated
05/13/2025
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