Provider Demographics
NPI:1326585779
Name:PROVIDENCE HEALTH & SERVICES WA
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES WA
Other - Org Name:PROVIDENCE HEALTH CARE HEALTH HOMES
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER OF POPULATION HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-474-4817
Mailing Address - Street 1:44 W 6TH AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2306
Mailing Address - Country:US
Mailing Address - Phone:509-474-4817
Mailing Address - Fax:
Practice Address - Street 1:44 W 6TH AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2306
Practice Address - Country:US
Practice Address - Phone:509-474-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management