Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
PROVIDENCE CRISIS RECOVERY CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
3760 PIPER ST, SUITE LL 139, ANCHORAGE, AK 99508-4665
(907) 563-5006
(907) 563-3217
Mailing address
PO BOX 4105, PORTLAND, OR 97208-4105
(866) 907-1068
(425) 917-9141
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
NOT NUMBERED
AK
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
512146
AK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1021061
—
AK
05
—
1584965
—
AK
01
—
512146
STATE OF ALASKA COMMUNITY CARE LICENSE
AK
05
—
MH3715
—
AK
Enumeration date
10/11/2006
Last updated
05/12/2025
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