# PROVIDENCE HEALTH & SERVICES - WASHINGTON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Adolescent Residential Treatment Program
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659483113
- **Authorized official:** DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 3210 W 62ND AVE, ANCHORAGE, AK 99502
- **Practice address phone:** (907) 212-2040
- **Practice address fax:** (907) 272-2169
- **Mailing address:** 3760 PIPER ST, SUITE 1061, ANCHORAGE, AK 99508-4665
- **Mailing address phone:** (907) 212-0209
- **Mailing address fax:** (907) 212-6547

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | 400157 | AK | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 05/15/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | HS487PI | — | AK |