NPIMap

Organization Active NPI

Providence Health & Services - Wa

  • Psychiatric Hospital Unit
  • Spokane, WA
National Provider Identifier
1639320484
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
PROVIDENCE HEALTH & SERVICES - WA
Practice address
101 W 8TH Ave
Spokane, WA 99204-2307
Phone
(509) 474-3131
NPI assigned
Oct 9, 2008
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 2

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

Facilities with the same owner 141

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

View all 141

Practitioners 6

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

Medicare participation

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

Hospital certification: CCN 50S054

Legal name
PROVIDENCE HEALTH & SERVICES - WA
Doing business as
PROV SACRED HRT MED CTR & CHILDS HOSP
Organization structure
CorporationNon-profit
Enrollment address
101 W 8TH Ave
Spokane, WA 99204-2307
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081119000897 WA Part A Provider - Hospital 5799845830 Practice locations: Spokane, WA

All disclosed owners & managing parties 24

Medicare enrollment files

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 Director Jul 1, 2016
Richard S Blair Individual Corporate Director 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, 2011 100%
Operational/Managerial Control Oct 17, 2008
Susan Stacey Individual Corporate Officer Dec 5, 2021
W-2 Managing Employee Dec 5, 2021
Mary E Lyons Individual Corporate Director Jul 1, 2016
Phyllis M Hughes Individual Corporate Director 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/Treasurer Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorDirector Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard of Directors Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard of Director Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016
Mary Beth Kingston Individual Corporate Director Sep 1, 2022
Eric D Sprunk Individual Corporate Director 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

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

101 W 8TH Ave
Spokane, WA 99204-2307

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110
Phone (509) 474-3131

Other names 1

NPPES NPI Registry
  • Prov Scred Hrt Med Ctr & Chlds Hos Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 7, 2025.

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1639320484",
    "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": "509-474-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042307",
            "telephone_number": "509-474-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-09",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prov Scred Hrt Med Ctr & Chlds Hos",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Prov Scred Hrt Med Ctr & Chlds Hos",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.