NPIMap

Organization Active NPI

Providence Health & Services Washington

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Hoquiam, WA
National Provider Identifier
1770714693
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PROVIDENCE HEALTH & SERVICES WASHINGTON
Practice address
508 1/2 Eighth Street
Hoquiam, WA 98550-3521
Phone
(360) 533-8813
Fax
(360) 533-1016
NPI assigned
Jul 28, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X

Addresses

Primary practice location

508 1/2 Eighth Street
Hoquiam, WA 98550-3521

Mailing address

PO Box 34439
Seattle, WA 98124-1439
Phone (425) 525-6778

Other names 1

  • Providence St Peter Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040227000744 WA Part B Supplier - Clinic/Group Practice 7719873496 Receives reassigned benefits from 189 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: South Bend, WA; Olympia, WA; Lacey, WA; Centralia, WA; Long Beach, WA

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

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1770714693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439",
            "telephone_number": "425-525-6778",
            "fax_number": "425-525-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 1/2 EIGHTH STREET",
            "city": "HOQUIAM",
            "state": "WA",
            "postal_code": "985503521",
            "telephone_number": "360-533-8813",
            "fax_number": "360-533-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "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": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence St Peter Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hoquiam, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.