# PROVIDENCE HEALTH & SERVICES - WASHINGTON

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Kodiak Home Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891899597
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1915 E REZANOF DR, KODIAK, AK 99615-6602
- **Practice address phone:** (907) 486-3281
- **Practice address fax:** (907) 486-9546
- **Mailing address:** PO BOX 3706, PORTLAND, OR 97208-3706
- **Mailing address phone:** (907) 486-3281
- **Mailing address fax:** (907) 486-9546

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 309115 | AK | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 05/13/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | CMG658 | — | AK |
| 05 | — | HH3281 | — | AK |
| 05 | — | MS4793 | — | AK |
| 05 | — | NA1431 | — | AK |
| 05 | — | PCG534A | — | AK |