Providence Health & Services Washington

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

77 Issued in WA

Legal business name

PROVIDENCE HEALTH & SERVICES WASHINGTON

Doing business as

Providence Mount St Vincent

Practice address

4831 35TH Ave SW
Seattle, WA 98126-2709

Phone

(206) 937-3700

Fax

(206) 938-8999

NPI assigned

Dec 8, 2005

Organization subpart

No

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

Authorized official

Name

Donald W Anderson Jr.

Title

Assistant Secretary Enrollment

Phone

(425) 358-9786

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PROVIDENCE MOUNT ST VINCENT Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Skilled nursing facility certification: CCN 505182

Legal name

PROVIDENCE HEALTH & SERVICES WASHINGTON

Doing business as

PROVIDENCE MOUNT ST VINCENT

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 1, 1968

Last certification

Jan 10, 2025

Beds

215

Ownership / control type

Nonprofit Corporation

Multi-facility organization

Providence

Organization structure

CorporationNon-profit

Incorporated

Jan 28, 1859 in WA

Enrollment address

4831 35TH Ave SW
Seattle, WA 98126-2709

Nursing home name

PROVIDENCE MOUNT ST VINCENT

Affiliated entity

PROVIDENCE HEALTH & SERVICES

Listed as

Providence Mount St VincentCCN 505182 · All quality measures

Overall star rating

3 of 5

Health inspections

2 of 5

Staffing

5 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Apr 1, 1968

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

215185.4 residents per day on average

Chain

Providence Health & Services8 facilities in the chain

Penalties (3 years)

3Fines totaling $129,568

Processed by Care Compare on Aug 1, 2026.

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.

• Sisters of Providence in Washington

  dba Providence Mount Saint Vincent

  • Adult Day Care Clinic/Center
  • Seattle, WA
  • NPI 1366634503
  NPD tax ID

All disclosed owners & managing parties 31

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

Owners & managing parties with NPI records 2

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

• Oksana Nesterenko, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1871229047

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Darryl A Elmouchi, MD

  • Clinical Cardiac Electrophysiology Physician
  • Grand Rapids, MI
  • NPI 1548240732

  Adp of the SNF, Corporate Officer, Operational/Managerial Control

  CMS ownership

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

  CMS ownership

Practitioners 3

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

• Arash Mirzaie Amirabadi, MD

  • Family Medicine Physician
  • Bellevue, WA
  • NPI 1750679767
  NPD (past)
• Oksana Nesterenko, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1871229047
  NPD (past)
• Amy Nicole Wilkerson, MD

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1194920603
  NPD (past)

Affiliated clinicians 2

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

• Oksana Nesterenko, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1871229047

  Nursing home

  Care Compare affiliation
• Amy Nicole Wilkerson, MD

  • Family Medicine Physician
  • Seattle, WA
  • NPI 1194920603

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1952386369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4831 35TH AVE SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981262709",
            "telephone_number": "206-937-3700",
            "fax_number": "206-938-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4831 35TH AVE SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981262709",
            "telephone_number": "206-937-3700",
            "fax_number": "206-938-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-08",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "BH-198",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "77",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41-07702",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE MOUNT ST VINCENT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MOUNT ST VINCENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence
• Providence Audiology (Seattle Hearing and Balance Center)
• Providence Health & Services - Washington
• Providence Health & Services - Washington (Providence Hospice of Seattle)
• Providence Health & Services - Washington (Providence ElderPlace)
• Providence Health and Services
• Kristin Ann Province, ARNP
• Jessica Provost, ARNP, DNP
• Matthew Vaughn Edward Provost
• Tracy L Provost, PT

• Skilled Nursing Facility in Seattle, WA
• Providers in Seattle, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.