Provider Demographics
NPI:1417209628
Name:PROVIDENCE
Entity Type:Organization
Organization Name:PROVIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HRYCENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-474-3131
Mailing Address - Street 1:101 W 8TH AVENUE
Mailing Address - Street 2:PROVIDENCE HOSPITAL
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2307
Mailing Address - Country:US
Mailing Address - Phone:509-474-3131
Mailing Address - Fax:
Practice Address - Street 1:101 W 8TH AVENUE
Practice Address - Street 2:PROVIDENCE HOSPITAL
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17440000000X282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren