1881681518 NPI number — PROVIDENCE HEALTH & SERVICES - WASHINGTON

Table of content: (NPI 1881681518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881681518 NPI number — PROVIDENCE HEALTH & SERVICES - WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PROVIDENCE ELDERPLACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881681518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 LIND AVE SW
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-320-5325
Provider Business Mailing Address Fax Number:
206-760-6339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4515 MARTIN LUTHER KING JR WAY S
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-320-5325
Provider Business Practice Location Address Fax Number:
206-760-6339
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
206-320-5325

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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