| Organization Name: | PROVIDENCE HEALTH CARE |
| NPI Number: | 1528154929 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY PECK (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 500 E Webster Ave Chewelah |
| State: | WA US |
| Postal Code: | 991099523 |
| Phone Number: | 5099358211 |
| Fax Number: | 5099355205 |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 11/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | H-194 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |