| Organization Name: | PROVIDENCE HEALTH & SERVICES WASHINGTON |
| NPI Number: | 1073744850 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE QUINN (PAYOR CREDENTIALING MANAGER) |
| Mailing Address: | 2505 Olympic Hwy N. Ste 140 Shelton |
| State: | WA US |
| Postal Code: | 985842978 |
| Phone Number: | 3604328692 |
| Fax Number: | 3604329902 |
| NPI Enumeration Date: | 07/28/2009 |
| NPI Last Update Date: | 12/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 276400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Hospital Units |
| Taxonomy Classification: | Rehabilitation, Substance Use Disorder Unit |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.) |