NPIMap

Organization Active NPI

Providence Health & Services- Washington

  • Rehabilitation Hospital
  • Spokane, WA
National Provider Identifier
1497752091
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
PROVIDENCE HEALTH & SERVICES- WASHINGTON
Practice address
711 S Cowley St
Spokane, WA 99202-1330
Phone
(509) 473-6000
Fax
(509) 473-6097
NPI assigned
Jun 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X
Rehabilitation Hospital 283X00000X Primary

Addresses

Primary practice location

711 S Cowley St
Spokane, WA 99202-1330

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110
Phone (509) 473-6000

Other names 1

  • Providence St Lukes Rehabilitation Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201209000555 WA Part A Provider - Hospital 9739236555 Practice locations: Spokane, WA; Spokane Valley, WA

Hospital certification: CCN 503025

Legal name
PROVIDENCE HEALTH & SERVICES- WASHINGTON
Doing business as
PROVIDENCE ST LUKES REHABILITATION MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Sep 20, 1994
Last certification
Sep 18, 2025
Beds
102
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Jan 28, 1859 in WA
Enrollment address
711 S Cowley St
Spokane, WA 99202-1330
Main/Primary Hospital Location
Hospital subgroups
Acute care, Rehabilitation

Other NPIs with the same Medicare PAC ID 1

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 Luke'S Rehabilitation Medical CenterCCN 503025
Ownership
Non-profit
Certified
Sep 20, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Services Washington2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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 16, 2016
Richard S Blair Individual Corporate DirectorBoard of Directors Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard of Directors Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Justin Voelker Individual W-2 Managing EmployeeFinancial Executive Jul 1, 2024
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2021
Operational/Managerial Control Jan 1, 2021
Nancy Webster Individual W-2 Managing EmployeeChief Jan 1, 2021
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
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 OfficerPresident/Ceo & Treasurer Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Jan 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 Other Jan 1, 2021
Mary Beth Kingston Individual Corporate DirectorBoard of Directors Sep 1, 2022
Eric D Sprunk Individual Corporate DirectorBoard Member 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 Other Jan 1, 2021

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 139

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

View all 139

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 98

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

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1497752091",
    "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",
            "telephone_number": "509-473-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 S COWLEY ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021330",
            "telephone_number": "509-473-6000",
            "fax_number": "509-473-6097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES- WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence St Lukes Rehabilitation Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.