Provider Demographics
NPI:1861995714
Name:PEACEHEALTH
Entity type:Organization
Organization Name:PEACEHEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP CHIEF FINAN-GROWTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-729-1102
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 328
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8003
Mailing Address - Country:US
Mailing Address - Phone:360-729-1404
Mailing Address - Fax:360-501-7565
Practice Address - Street 1:2000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4327
Practice Address - Country:US
Practice Address - Phone:360-856-6021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEACEHEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-16
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035332Medicaid