Organization Name: | PROVIDENCE HEALTH & SERVICES - WA |
NPI Number: | 1821240425 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JIM LIPPOLD (EXECUTIVE DIRECTOR) |
Mailing Address: | 6018 N Astor St Spokane |
State: | WA US |
Postal Code: | 992081107 |
Phone Number: | 5094822475 |
Fax Number: | 5094822490 |
NPI Enumeration Date: | 10/15/2008 |
NPI Last Update Date: | 10/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |