Organization
PROVIDENCE HEALTH & SERVICES WASHINGTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
420 GOLF CLUB RD SE, SUITE 203, LACEY, WA 98503-1048
(360) 493-7469
(360) 459-2023
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
(425) 525-6717
(425) 525-6700
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
H-159
WA
Other
Enumeration date
07/16/2007
Last updated
07/25/2025
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