NPI 1407945389

Providence Health & Services - Washington

Organisation Mental Illness Community Based Residential Treatment Facility Anchorage, AK

Practice location

Address: 3760 Piper St Suite Ll 139, Anchorage, AK 99508-4665
Phone: (907) 563-5006
Fax: (907) 563-3217
Mailing address: PO Box 4105, Portland, OR 97208-4105

Authorised official

Name: Donald Wayne Anderson
Title: Assistant Secretary of Enrollments
Phone: (425) 358-9786

Registered specialties (6)

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence NOT NUMBERED (AK)

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Psychiatry Physician

Allopathic & Osteopathic Physicians Taxonomy 2084P0800X

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Addiction Psychiatry Physician

Allopathic & Osteopathic Physicians Taxonomy 2084P0802X

Community/Behavioral Health Agency

Agencies Taxonomy 251S00000X

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Emotionally Disturbed Childrens' Residential Treatment Facility

Residential Treatment Facilities Taxonomy 322D00000X Licence 512146 (AK)

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Psychiatric/Mental Health Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LP0808X

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Registry record

NPI: 1407945389
Entity type: Organization
NPI issued: 11 Oct 2006
Record last updated: 12 May 2025

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.