NPIMap

Organization Active NPI

Providence Health & Services - Washington

  • Rehabilitation Hospital Unit
  • Walla Walla, WA
National Provider Identifier
1467603282
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
H-050 Issued in WA
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Practice address
401 W Poplar St
Walla Walla, WA 99362-2846
Phone
(509) 522-5821
Fax
(509) 522-5752
NPI assigned
Oct 10, 2008
Last updated
Jan 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Authorized official

Name
Mr. Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X H-050 WA Primary

Addresses

Primary practice location

401 W Poplar St
Walla Walla, WA 99362-2846

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110

Other names 1

  • Providence St Mary Rehab Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081119000651 WA Part A Provider - Hospital 2860552973 Practice locations: Walla Walla, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467603282. Details of each certification follow.

Hospital certification: CCN 50T002

Legal name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Doing business as
PROVIDENCE ST MARY MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 1859 in WA
Enrollment address
401 W Poplar Street
Walla Walla, WA 99362-2846
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Providence St Mary Medical CenterCCN 50T002 · All quality measures
Ownership
Non-profit
Certified
Jan 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Service17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member - Chair Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard of Directors Jan 1, 2024
Aslam Reza Kaleel Individual Corporate Officer Apr 15, 2022
W-2 Managing Employee Apr 15, 2022
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 17, 2008 100%
Operational/Managerial Control Oct 17, 2008
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
David McKay Individual W-2 Managing EmployeeDirector Clinical Operations Feb 9, 2015
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAssistant Treasurer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerEvp/Cfe/Treasurernow Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard of Directors Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorBoard of Directors Sep 1, 2022
Eric D Sprunk Individual Corporate DirectorBoard of Directors Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident & Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • CP King County Wa HH, LLC

    dba Providence at Home with Compassus Home Health, King

    • Home Health Agency
    • Tukwila, WA
    • NPI 1972325983

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP Seattle Wa Hospice, LLC

    dba Providence at Home with Compassus Hospice Care, Puget Sound

    • Community Based Hospice Care Agency
    • Tukwila, WA
    • NPI 1174345193

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP Snohomish County Wa, LLC

    dba Providence at Home with Compassus Home Health, Snohomish County

    • Community Based Hospice Care Agency
    • Everett, WA
    • NPI 1184446221

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP Snohomish County Wa, LLC

    dba Providence at Home with Compassus Hospice Care, Snohomish County

    • Home Health Agency
    • Everett, WA
    • NPI 1720800857

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP Sound Wa, LLC

    dba Providence at Home with Compassus Hospice Care, Puget Sound South

    • Community Based Hospice Care Agency
    • Lacey, WA
    • NPI 1659193795

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP Sound Wa, LLC

    dba Providence at Home with Compassus Home Health, Puget Sound South

    • Home Health Agency
    • Lacey, WA
    • NPI 1669294708

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP Spokane Wa HH, LLC

    dba Providence at Home with Compassus Home Health, INWA

    • Home Health Agency
    • Spokane Valley, WA
    • NPI 1033931043

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • CP St. Mary Wa HH, LLC

    dba Providence at Home with Compassus Home Health, Walla Walla

    • Home Health Agency
    • Walla Walla, WA
    • NPI 1730901745

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • Kadlec Regional Medical Center
    • General Acute Care Hospital
    • Richland, WA
    • NPI 1972507580

    Providence Health & Services - Washington

    CMS ownership
  • Northwest Washington Rehabilitation Hospital LLC

    dba Providence Swedish Rehabilitation Hospital

    • Rehabilitation Hospital
    • Lynnwood, WA
    • NPI 1306628821

    Providence Health & Services - Washington

    CMS ownership
  • Providence Health & Services - Wa

    dba Prov Scred Hrt Med Ctr & Chlds Hos

    • General Acute Care Hospital
    • Spokane, WA
    • NPI 1144471715

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
  • Providence Health & Services - Wa

    dba Providence St Joseph Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Chewelah, WA
    • NPI 1447402839

    Providence Health & Services, Providence Health & Services - Washington, Providence St. Joseph Health

    CMS ownership
View all 141

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737676800000",
    "number": "1467603282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W POPLAR ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622846",
            "telephone_number": "509-522-5821",
            "fax_number": "509-522-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-10",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "WA",
            "license": "H-050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence St Mary Rehab",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Providence St Mary Rehab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.