Provider Demographics
NPI:1679763668
Name:PROVIDENCE HEALTH & SERVICES-WASHINGTON
Entity type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES-WASHINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSELBLAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-464-7107
Mailing Address - Street 1:910 N WASHINGTON
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2260
Mailing Address - Country:US
Mailing Address - Phone:509-232-1173
Mailing Address - Fax:509-232-1196
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-3131
Practice Address - Fax:509-474-4925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVIDENCE HEALTH & SERVICES-WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH162171M00000X
WAH 162282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
500054Medicare Oscar/Certification