Organization
PROVIDENCE HEALTH & SERVICES
Active
Organization
PROVIDENCE HEALTH & SERVICES
Active
Other names
PMG NW WA Health Home
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
12800 BOTHELL EVERETT HWY, SUITE 290, EVERETT, WA 98208-6642
(425) 261-3330
Mailing address
12800 BOTHELL EVERETT HWY, SUITE 290, EVERETT, WA 98208-6642
(425) 261-3330
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
02/27/2017
Last updated
07/25/2025
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