PROVIDENCE SENIOR HOME LLC
NPI 1134520463
Health Maintenance Organization in Spokane, WA

Active since September 05, 2014CLIA 50D2294218 · Waiver
3623 W INDIAN TRAIL RD, SPOKANE, WA 99208(509) 710-2776 Get Directions Write a Review

NPPES record last updated: September 5, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Providence Senior Home Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE SENIOR HOME LLC (NPI 1134520463) is a healthcare organization registered as a health maintenance organization in Spokane, Washington and active in the NPI registry since September 2014. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Sandu Codreanu, Owner/provider, as its authorized official.

NPPES Registry Identity

NPI1134520463
Entity TypeOrganization
Primary Taxonomy302R00000X
Legal Business NamePROVIDENCE SENIOR HOME LLC
Location Address3623 W INDIAN TRAIL RDSpokane, WA 99208
Mailing Address3623 W Indian Trail RdSpokane, WA 99208-4733 · (509) 638-8738 · Fax (509) 326-6468
Organization SubpartNo
Authorized OfficialSandu CodreanuOwner/provider · (509) 638-8738
Enumeration DateSeptember 5, 2014
NPI 1134520463 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyHealth Maintenance OrganizationManaged Care Organizations
Taxonomy Code302R00000X
License Licensed in WA · A752165
Definition
(1) A form of health insurance in which its members prepay a premium for the HMO's health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model.
3623 W INDIAN TRAIL RD, Spokane, WA 99208

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2294218

Providence Senior Home · Spokane, WA
Active · expires Apr 4, 2028
CLIA Number50D2294218
Laboratory TypeAfh
Certificate Effective DateNovember 20, 2023
Certificate Expiration DateApril 4, 2028
Laboratory DirectorSandu Codreanu
Laboratory Phone(509) 514-2791
Laboratory LocationProvidence Senior Home8920 N Pamela St, Spokane, WA 99208
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Licensed Practical Nurse
3623 W INDIAN TRAIL RD
SPOKANE, WA 99208

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Senior Home LLC's NPI number?

The NPI number for Providence Senior Home LLC is 1134520463. It was assigned to this organization in the NPPES registry on September 5, 2014.

Where is Providence Senior Home LLC located?

Providence Senior Home LLC is located at 3623 W Indian Trail Rd, Spokane, WA 99208. The listed phone number is (509) 710-2776.

What is Providence Senior Home LLC's specialty?

The primary specialty registered for this NPI is Health Maintenance Organization with taxonomy code 302R00000X.

Does Providence Senior Home LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2294218) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Providence Senior Home LLC was last updated on September 5, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.