Provider Demographics
NPI:1902497308
Name:PROVIDENCE HEALTH & SERVICES- WASHINGTON
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES- WASHINGTON
Other - Org Name:PROVIDENCE ST LUKES REHABILITATION MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST SEC FOR ENROLLMENT/DIR REIMB S
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-2185
Mailing Address - Country:US
Mailing Address - Phone:509-473-6000
Mailing Address - Fax:
Practice Address - Street 1:711 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1330
Practice Address - Country:US
Practice Address - Phone:509-473-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No283X00000XHospitalsRehabilitation HospitalGroup - Single Specialty