Providence Health & Services-Wa

Primary specialty

Rehabilitation Hospital UnitTaxonomy code 273Y00000X

Legal business name

PROVIDENCE HEALTH & SERVICES-WA

Practice address

916 Pacific Ave
Everett, WA 98201-4147

Phone

(425) 258-7304

Fax

(425) 258-7136

NPI assigned

Oct 7, 2008

Last updated

Jul 25, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donald Wayne Anderson Jr.

Title

Asst Secretary-Enrollment

Phone

(425) 358-9786

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730330838. Details of each certification follow.

• CCN 500009 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 500009

Legal name

PROVIDENCE HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Jan 1, 1995

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Dec 18, 1990

Beds

218

Ownership / control type

Church

Most recent change of ownership

Feb 28, 1994 (1 total)

Facility address

916 Pacific Ave (P O Box 1067)
Everett, WA 98201

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.

• Dara L Headrick, DO

  • Physical Medicine & Rehabilitation Physician
  • Everett, WA
  • NPI 1912963711
  NPD (past)

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1730330838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3369",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 PACIFIC AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014147",
            "telephone_number": "425-258-7304",
            "fax_number": "425-258-7136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES-WA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "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": "ASST SECRETARY-ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Health & Services-Wa (PMG NW Wa OB GYN Hospitalists)
• Providence Health & Services-Wa
• Providence Health & Services-Wa
• Providence Health & Services-Wa (Providence Regional Medical Center Everett)
• Providence Health & Services-Wa
• Providence Health & Services-Wa
• Providence Health & Services-Wa (Providence Everett Medical Labs)
• Providence Health & Services-Wa (Providence Physician Group- Neurosurgery and Spine Clinic)
• Providence Health & Services-Wa
• Providence Health & Services-Washington (PMG NW WA Cardiovascular and Thoracic Surgery)

• Rehabilitation Hospital Unit in Everett, WA
• Providers in Everett, WA by specialty
• Rehabilitation Hospital Unit in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.