# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence St. Peter Chemical Dependency Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073677605
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECREATRY FOR ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 506 W FRANKLIN ST, SHELTON, WA 98584-3517
- **Practice address phone:** (360) 432-8692
- **Mailing address:** 909 N BROADWAY, PBO/CREDENTIALING, EVERETT, WA 98201-1409
- **Mailing address phone:** (425) 317-0246
- **Mailing address fax:** (425) 317-0291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 276400000X | Substance Use Disorder Rehabilitation Hospital Unit | — | NULL | Yes |

## Other

- **Enumeration date:** 12/20/2006
- **Last updated:** 05/13/2025