Organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Active
Other names
Providence Adolescent Residential Treatment Program
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W. ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
3210 W 62ND AVE, ANCHORAGE, AK 99502
(907) 212-2040
(907) 272-2169
Mailing address
3760 PIPER ST, SUITE 1061, ANCHORAGE, AK 99508-4665
(907) 212-0209
(907) 212-6547
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
400157
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HS487PI
—
AK
Enumeration date
08/31/2006
Last updated
05/15/2025
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