Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PROV HOSPICE & H C OF SNOHOMISH CTY
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1615 75TH ST SW STE 210, EVERETT, WA 98203-6293
(425) 261-4800
(425) 261-4868
Mailing address
1615 75TH ST SW STE 210, EVERETT, WA 98203-6293
(425) 261-4800
(425) 261-4868
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
—
—
251G00000X
Community Based Hospice Care Agency
Primary
IHS.FS.00000418
WA
251G00000X
Community Based Hospice Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
315D00000X
Inpatient Hospice
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009255
—
WA
Enumeration date
09/14/2009
Last updated
05/16/2025
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