# THE SALVATION ARMY BOOTH MEMORIAL RESIDENTIAL CHILDCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265656730
- **Authorized official:** ADELANE M KELLY (DIVISIONAL FINANCE DIRECTOR)
- **Authorized official phone:** (907) 339-3406

## Contact information

- **Practice address:** 3600 E 20TH AVE, ANCHORAGE, AK 99508-3416
- **Practice address phone:** (907) 279-0522
- **Mailing address:** 143 E 9TH AVE, ANCHORAGE, AK 99501-3618
- **Mailing address phone:** (907) 339-3406
- **Mailing address fax:** (907) 276-2611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 11806 | AK | Yes |

## Other

- **Enumeration date:** 04/13/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | BR0005 | — | AK |