NPIMap

Organization Active NPI

Providence Health & Services - Washington

Doing business as Providence St Peter Chemical Dependency Center

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Lacey, WA
National Provider Identifier
1467462952
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Doing business as
Providence St Peter Chemical Dependency Center
Practice address
4800 College St SE
Lacey, WA 98503-4389
Phone
(360) 456-7575
Fax
(360) 493-5088
NPI assigned
Aug 8, 2006
Last updated
Jul 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 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 Secreatry for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X Primary

Addresses

Primary practice location

4800 College St SE
Lacey, WA 98503-4389

Mailing address

909 N Broadway
Pbo/Credentialing
Everett, WA 98201-1409
Phone (425) 317-0246

Other names 1

  • Providence St Peter Chemical Dependency Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311001453 WA Part B Supplier - Clinic/Group Practice 0345139929 Receives reassigned benefits from 946 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20151222000687 MT Part B Supplier - Clinic/Group Practice 0345139929 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somers, MT; Missoula, MT; Lolo, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467462952. Details of each certification follow.

Hospital certification: CCN 500143

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PROVIDENCE ST PETER CHEMICAL DEPENDENCY CENTER
Certification status
Terminated Voluntary: merger or closure, Jun 30, 2009
Provider type (POS)
Hospital – Short-term
Participating since
Nov 15, 1990
Last certification
Feb 27, 1997
Beds
50
Ownership / control type
Church
Facility address
4800 College Street SE
Lacey, WA 98503

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1467462952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 N BROADWAY",
            "address_2": "PBO/CREDENTIALING",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011409",
            "telephone_number": "425-317-0246",
            "fax_number": "425-317-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 COLLEGE ST SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985034389",
            "telephone_number": "360-456-7575",
            "fax_number": "360-493-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECREATRY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence St Peter Chemical Dependency Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lacey, WA

Sources for this page

Verify at the official NPI Registry.