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Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence Kodiak Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1915 E REZANOF DR, KODIAK, AK 99615-6602
(907) 486-3281
(907) 486-9546
Mailing address
PO BOX 3706, PORTLAND, OR 97208-3706
(907) 486-3281
(907) 486-9546
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
309115
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG658
—
AK
05
—
HH3281
—
AK
05
—
MS4793
—
AK
05
—
NA1431
—
AK
05
—
PCG534A
—
AK
Enumeration date
09/12/2006
Last updated
05/13/2025
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