Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence St Mary 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
380 CHASE AVE, WALLA WALLA, WA 99362-2924
(509) 897-8600
Mailing address
PO BOX 84812, SEATTLE, WA 98124-6112
(509) 897-8600
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
IS446
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074073
L&I
WA
05
—
9109703
—
WA
Enumeration date
10/10/2008
Last updated
05/07/2025
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