NPI 1134520463

Providence Senior Home LLC

Organisation Health Maintenance Organization Spokane, WA

Practice location

Address: 3623 W Indian Trail Rd, Spokane, WA 99208
Phone: (509) 710-2776
Mailing address: 3623 W Indian Trail Rd, Spokane, WA 99208-4733

Authorised official

Name: Sandu Codreanu
Title: Owner/Provider
Phone: (509) 638-8738

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence A752165 (WA)

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Registry record

NPI: 1134520463
Entity type: Organization
NPI issued: 5 Sep 2014
Record last updated: 5 Sep 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.