Provider Demographics
NPI:1295987881
Name:PROVIDENCE HEALTH & SERVICES - WA
Entity type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES - WA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-474-2153
Mailing Address - Street 1:34 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-7210
Mailing Address - Country:US
Mailing Address - Phone:509-474-2550
Mailing Address - Fax:509-474-2618
Practice Address - Street 1:34 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-7210
Practice Address - Country:US
Practice Address - Phone:509-474-2550
Practice Address - Fax:509-474-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA512537Medicaid