PROVIDENCE HEALTH & SERVICES WASHINGTON
NPI 1366641755
Clinic/Center - Rehabilitation, Substance Use Disorder in Lacey, WA

Q: What is Providence Health & Services Washington's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

Active since July 16, 2007

4800 COLLEGE ST SE, LACEY, WA 98503(360) 456-7575(360) 493-5088 Get Directions Write a Review

NPPES record last updated: May 15, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Providence Health & Services Washington NPPES

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

PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI 1366641755) is a healthcare organization registered as a rehabilitation, substance use disorder in Lacey, Washington and active in the NPI registry since July 2007. The organization lists Donald Wayne Anderson, Assistant Secreatry For Enrollment, as its authorized official.

NPPES Registry Identity

NPI1366641755

Entity TypeOrganization

Primary Taxonomy261QR0405X

Legal Business NamePROVIDENCE HEALTH & SERVICES WASHINGTON

Location Address4800 COLLEGE ST SELacey, WA 98503-4389

Mailing AddressPo Box 34439Seattle, WA 98124-1439 · (425) 525-6778 · Fax (425) 525-6700

Phone(360) 456-7575

Fax(360) 493-5088

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secreatry For Enrollment · (425) 358-9786

Enumeration DateJuly 16, 2007

Last NPPES UpdateMay 15, 2025

NPPES CertifiedMay 15, 2025

✔ NPI 1366641755 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities

Taxonomy Code261QR0405X

License✔ Licensed in WA · 34 0153 00

4800 COLLEGE ST SE, Lacey, WA 98503

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Other Names 1

Other NameProvidence St Peter Hospital - 2nd Claims

Other Providers at the Same Location NPPES 20

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

JUMAN PARK DPT

Physical Therapist

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

DR. ABRAHAM WUSEOK JEON DO

Family Medicine

4800 COLLEGE ST SE, PMG SW WA LACEY FAM MED
LACEY, WA 98503

Thurston County (360) 486-2900

GRIGORIY A ROZENFELD DO

Emergency Medicine

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

KAREN LEE NEWMAN

Counselor

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 493-5722

IAN SERRATO

Nurse Practitioner (Family)

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 493-4500

MICHAELA JANE DE GROOT PT, DPT

Physical Therapist

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

CARA ELIZABETH BARDWELL PA-C

Physician Assistant

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

STEPHANIE MARY DEMPSEY RN

Registered Nurse

4800 COLLEGE ST SE
LACEY, WA 98503

Thurston County (360) 486-2900

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 Health & Services Washington's NPI number?

The NPI number for Providence Health & Services Washington is 1366641755. It was assigned to this organization in the NPPES registry on July 16, 2007. The provider is also known as Providence St Peter Hospital - 2nd Claims.

Where is Providence Health & Services Washington located?

Providence Health & Services Washington is located at 4800 College St SE, Lacey, WA 98503. The listed phone number is (360) 456-7575.

What is Providence Health & Services Washington's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

When was this NPI record last updated?

The NPPES record for Providence Health & Services Washington was last updated on May 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months 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.