Providence Senior Home LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

A752165 Issued in WA

Legal business name

PROVIDENCE SENIOR HOME LLC

Practice address

3623 W Indian Trail Rd
Spokane, WA 99208

Phone

(509) 710-2776

NPI assigned

Sep 5, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Sandu Codreanu, NAC

Title

Owner/Provider

Phone

(509) 638-8738

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409875200000",
    "number": "1134520463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3623 W INDIAN TRAIL RD",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992084733",
            "telephone_number": "509-638-8738",
            "fax_number": "509-326-6468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 W INDIAN TRAIL RD",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "99208",
            "telephone_number": "509-710-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SENIOR HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-05",
        "status": "A",
        "authorized_official_last_name": "CODREANU",
        "authorized_official_first_name": "SANDU",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "509-638-8738",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NAC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "WA",
            "license": "A752165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Health & Services-Wa
• Providence Health & Services-Washington
• Providence Physician Services Co
• Providence Physician Services Co.
• Providence Sacred Heart Medical Center
• Providential Solutions LLC
• Anna Edith Pruett, OT
• Derika Lacole Pruitt
• Kelsey Elizabeth Pruitt, PA-C
• Oksana Prychyna, MD

• Health Maintenance Organization in Spokane, WA
• Providers in Spokane, WA by specialty
• Health Maintenance Organization in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.