NPIMap

Organization Active NPI

Providence Health & Services - Washington

Doing business as Prov Hospice & H C of Snohomish Cty

  • Community Based Hospice Care Agency
  • Everett, WA
National Provider Identifier
1083947709
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
IHS.FS.00000418 Issued in WA
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Doing business as
Prov Hospice & H C of Snohomish Cty
Practice address
1615 75TH St SW Ste 210
Everett, WA 98203-6293
Phone
(425) 261-4800
Fax
(425) 261-4868
NPI assigned
Sep 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary Enrollment
Phone
(425) 358-9786

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hospice and Palliative Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080H0002X
Community Based Hospice Care Agency 251G00000X
Community Based Hospice Care Agency 251G00000X IHS.FS.00000418 WA Primary
In Home Supportive Care Agency 253Z00000X
Inpatient Hospice 315D00000X

Addresses

Primary practice location

1615 75TH St SW Ste 210
Everett, WA 98203-6293

Mailing address

1615 75TH St SW Ste 210
Everett, WA 98203-6293
Phone (425) 261-4800

Other identifiers 1

IdentifierTypeStateIssuer
1009255MedicaidWA

Other names 1

  • PROV HOSPICE & H C OF SNOHOMISH CTY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Feb 27, 2025 Change of OwnershipThis provider was the seller Providence at Home With Compassus, Snohomish CountyCCN 501514, WA, NPI 1184446221

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1083947709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 75TH ST SW STE 210",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036293",
            "telephone_number": "425-261-4800",
            "fax_number": "425-261-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 75TH ST SW STE 210",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036293",
            "telephone_number": "425-261-4800",
            "fax_number": "425-261-4868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-14",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "2080H0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WA",
            "license": "IHS.FS.00000418",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009255",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROV HOSPICE & H C OF SNOHOMISH CTY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.