PROVIDENCE HEALTH & SERVICE WASHINGTON (NPI# 1104024348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104024348 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICE WASHINGTON |
| Other Organization Name | PROVIDENCE ADDICTIONS RECOVERY CTR |
| Practice Address |
218-a Main Street Morton WA 98356-0000 |
| Mailing Address |
Po Box 34439 Seattle WA 98124-1439 |
| Practice Telephone | 3604966216 |
| Practice Fax Number | 3604966232 |
| Mailing Telephone | 4255256778 |
| Mailing Fax Number | 4255256700 |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2010-12-22 |
| Authorized Official Name | NICOLE QUINN (PAYOR CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4255256715 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | BUSINESS LICENSE | 1250 | 01 |
| WA | UBI MASTER LICENSE | 602 399 531 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Addictions Recovery Ctr | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245438738 | Providence Health & Service Washington | Psychologist | 1322 Commerce Ave, Longview, WA 98632-3718 | 2007-07-05 |
| 1124117197 | Providence Health & Service Washington | Clinic/Center | 1010 South Scheuber Rd, Suites 3 & 4, Centralia, WA 98531-8892 | 2006-10-11 |
| 1447490370 | Providence Health & Service Washington | Surgery | 1720 Cooks Hill Rd, Centralia, WA 98531-9071 | 2009-03-05 |
| 1124226360 | Providence Health & Service Washington | Psychologist | 1800 Cooks Hill Rd, Suite G, Centralia, WA 98531-9072 | 2007-07-10 |
| Street Address |
218-A MAIN STREET |
| City | MORTON |
| State | WA |
| Zip Code | 98356-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295299113 | Stephanie Jean Hemenway | Denturist | 209 W Main Ave., Morton, WA 98356 | 2019-01-24 |
| 1114438603 | Evergreen Health and Wellness, Ps | Chiropractor | 193 Main Ave, Suite A, Morton, WA 98356 | 2017-10-24 |
| 1346792207 | Naser Al Tameemi | Denturist | 209 W Main St., Morton, WA 98356 | 2016-10-26 |
| 1336522069 | New Era Denture Service | Denturist | 209 W. Main St., Morton, WA 98356 | 2015-06-30 |
| 1023368024 | Sandra L Demarest | Pharmacist | 377 South 2nd St., Morton, WA 98356 | 2012-09-17 |
| 1134442924 | Kindra R Keys | Massage Therapist | 209 Tilton View Rd., Morton, WA 98356 | 2010-03-08 |
| 1861697070 | Medical Vision Center, Ltd | Optometrist | 240 W. Main St., Morton, WA 98356 | 2007-06-18 |
| 1154468627 | Lewis County Fpd 4 | Ambulance | 105 Third St., Morton, WA 98356 | 2007-01-31 |
| 1851443212 | John A Swetz | Chiropractor | 118 2nd St, Morton, WA 98356 | 2007-01-17 |
| 1093818130 | Demarest Inc | Pharmacy | 377 S 2nd St, Morton, WA 98356 | 2006-09-06 |
| Find all providers in zip 98356 | ||||
| Taxonomy Code | 103TA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710411830 | Rickey L Jones | Psychologist | 5523 E Commerce Ave, Spokane, WA 99212-1306 | 2017-04-14 |
| 1851849855 | Yvonne Lynn Prouty | Psychologist | 1960 Thompson Dr, Sedro Woolley, WA 98284-5007 | 2016-09-19 |
| 1205088689 | Diedra L Clay | Psychologist | 2800 E Madison St Ste 320, Seattle, WA 98112-4871 | 2008-10-16 |
| 1659521912 | Wayne E Carr | Psychologist | 7800 N E Bothell Way, Suite 155 B, Kenmore, WA 98028 | 2008-09-23 |
| 1245438738 | Providence Health & Service Washington | Psychologist | 1322 Commerce Ave, Longview, WA 98632-3718 | 2007-07-05 |
| 1245208404 | James William Ethier | Psychologist | 238 N. Chelan Ave., Wenatchee, WA 98801-2105 | 2006-03-14 |
| 1689272395 | Kathryn Staats | Psychologist | 1016 Commercial St, Raymond, WA 98577-2631 | 2020-10-14 |
| 1992315519 | Christine Borland | Psychologist | 5929 Westgate Blvd Ste A, Tacoma, WA 98406-2567 | 2020-08-07 |
| 1750916086 | Ozark Gore | Psychologist | 4804 Lacey Blvd Se Ste A, Lacey, WA 98503-5733 | 2020-03-06 |
| 1740826502 | Angela Y Yoon | Psychologist | 8811 S Tacoma Way Ste 106, Lakewood, WA 98499-4595 | 2019-11-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.