Providence Health & Services Washington

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

IS-420 Issued in WA

Legal business name

PROVIDENCE HEALTH & SERVICES WASHINGTON

Practice address

4200 6TH Ave SE
Suite 201
Lacey, WA 98503-1042

Phone

(360) 459-8311

Fax

(360) 493-4657

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Donald Anderson Jr.

Title

Assistant Secretaary Enrollment

Phone

(425) 358-9786

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providence SoundHomeCare and Hospice Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• CP Sound Wa, LLC

  • Community Based Hospice Care Agency
  • Lacey, WA
  • NPI 1659193795

  Sold to, 2025-02-27

  CMS change of ownership

Practitioners 1

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

• Todd Michael Shelton, D.C.

  • Chiropractor
  • Chehalis, WA
  • NPI 1780738294
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1962592295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24666",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981240666",
            "telephone_number": "503-893-7120",
            "fax_number": "425-276-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 6TH AVE SE",
            "address_2": "SUITE 201",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031042",
            "telephone_number": "360-459-8311",
            "fax_number": "360-493-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "ASSISTANT SECRETAARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WA",
            "license": "IS-420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3990355",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence SoundHomeCare and Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence SoundHomeCare and Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Health & Services Washington
• Providence Health & Services Washington
• Providence Health & Services Washington
• Providence Health & Services Washington
• Providence Health & Services Washington
• Brooke Pruitt, LMHC
• PT Northwest of Longview, Inc
• Puget Sound Physical Therapy LLC
• Donna Quach
• Qualified Surgical Services PLLC

• Community Based Hospice Care Agency in Lacey, WA
• Providers in Lacey, WA by specialty
• Community Based Hospice Care Agency 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.