PROVIDENCE HEALTH & SERVICES - WASHINGTON (NPI# 1336764836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336764836 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Practice Address |
3760 Piper St Ste 1108 Anchorage AK 99508-4683 |
| Mailing Address |
Po Box 4105 Portland OR 97208-4105 |
| Practice Telephone | 9072126900 |
| Practice Fax Number | 9072126593 |
| Mailing Telephone | 8669071068 |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2020-06-10 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASSIST SECRETARY FOR ENROLLMENT) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| PROVIDENCE BEHAVIORAL HEALTH | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407162571 | Providence Health & Services - Washington | Internal Medicine | 510 E Amende Drive, Odessa, WA 99159-0000 | 2010-08-26 |
| 1841503034 | Providence Health & Services - Washington | Family Medicine | 18313 Paulsonst Sw, Suite A, Rochester, WA 98579-9262 | 2010-07-16 |
| 1083947709 | Providence Health & Services - Washington | Hospice Care, Community Based | 2731 Wetmore Ave Ste 500, Everett, WA 98201-3585 | 2009-09-14 |
| 1760636690 | Providence Health & Services - Washington | Neurological Surgery | 301 W Poplar Street, Ste 220, Walla Walla, WA 99362-2800 | 2008-11-05 |
| 1558512368 | Providence Health & Services - Washington | Home Health | 209 W Poplar St, Walla Walla, WA 99362 | 2008-10-10 |
| 1922259738 | Providence Health & Services - Washington | Internal Medicine | 380 Chase Avenue, Pmg Se Wa, Walla Walla, WA 99362-2924 | 2008-10-10 |
| 1306097126 | Providence Health & Services - Washington | Radiology | 401 W Poplar Street, Pmg Se Wa Imaging, Walla Walla, WA 99362-2846 | 2008-10-10 |
| 1043374119 | Providence Health & Services - Washington | Rehabilitation, Substance Use Disorder Unit | 508 Quarter Eighth Street, Hoquiam, WA 98550 | 2006-12-21 |
| 1073677605 | Providence Health & Services - Washington | Rehabilitation, Substance Use Disorder Unit | 506 W Franklin St, Shelton, WA 98584-3517 | 2006-12-20 |
| 1003906918 | Providence Health & Services - Washington | Home Health | 3432 Bay Rd Ne, Olympia, WA 98506-2958 | 2006-10-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Washington | 1801 Lind Ave. Sw, #9016, Renton, WA 98057 |
| Street Address |
3760 PIPER ST STE 1108 |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99508-4683 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992712442 | Heather Ellison Brock | Nurse Practitioner | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2006-08-01 |
| 1235771593 | Crystal S Harris | Counselor | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2019-10-08 |
| 1477102705 | Susan Ratcliffe | Counselor | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2019-09-09 |
| 1376192070 | Theresa Rutchka | Counselor | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2019-09-05 |
| 1194373464 | Phyllis Rose | Counselor | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2019-08-29 |
| 1376061788 | Diana Belen Waddell | Social Worker | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2017-09-06 |
| 1699228247 | Christopher Isaac Cox | Counselor | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2016-08-01 |
| 1477934636 | Matthew Mark Huckabee | Psychiatry & Neurology | 3760 Piper St Ste 1108, Anchorage, AK 99508 | 2015-06-14 |
| 1467839183 | Nathaniel J Bell | Psychiatry & Neurology | 3760 Piper St Ste 1108, Anchorage, AK 99508-4683 | 2015-05-01 |
| 1013255868 | Jasmine Porter | Counselor | 3760 Piper St Ste 1108, Anchorage, AK 99508 | 2013-01-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063349 | Alexandra L Davis | Student in an Organized Health Care Education/Training Program | 1202 E 36th Ave, Anchorage, AK 99508 | 2020-05-01 |
| 1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
| 1679120349 | Kila Gilcart | Speech-Language Pathologist | 161 Klevin Street #103, Anchorage, AK 99508 | 2019-08-19 |
| 1326692963 | Shannon Maillet | Behavior Technician | 1650 S Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1427602044 | Frank Harris Lawson Iv | Behavior Technician | 1650 S. Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1104470723 | Vivalesi Seforosa Nair | Behavior Technician | 1650 South Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1043864267 | The Cozy Chalet Assisted Living Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3707 Mt Blanc Circle, Anchorage, AK 99508 | 2019-07-25 |
| 1942861778 | Christine Mary Hoover | Registered Nurse | Alaska Native Medical Center - Inpatient Pediatrics, 4315 Diplomacy Dr, Anchorage, AK 99508 | 2019-06-24 |
| 1215594502 | Ashley Ongtowasruk | Case Manager/Care Coordinator | 4441 Dipomacy Dr, Suite 500, Anchorage, AK 99508 | 2019-05-22 |
| 1659937019 | Rayne Johnson | Behavior Technician | 4000 San Ernesto Blvd, Anchorage, AK 99508 | 2019-05-11 |
| Find all providers in zip 99508 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700483781 | Anchorage Community Mental Health Services, Inc | Community/Behavioral Health | 704 W 26th Ave, Anchorage, AK 99503-2532 | 2020-10-03 |
| 1184259855 | Alaska Youth and Family Network | Community/Behavioral Health | 740 Communications Ave, Anchorage, AK 99503-6000 | 2020-03-03 |
| 1033755798 | The Salvation Army, A California Corporation | Community/Behavioral Health | 1700 A Street, Anchorage, AK 99501 | 2019-11-18 |
| 1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
| 1639722069 | Southcentral Foundation | Community/Behavioral Health | 4175 Tudor Centre Dr, Anchorage, AK 99508-5917 | 2019-07-24 |
| 1659924025 | Southcentral Foundation | Community/Behavioral Health | 4341 Tudor Centre Dr Ste 300, Anchorage, AK 99508-5904 | 2019-07-24 |
| 1558878231 | Pinnacle Community Health, LLC | Community/Behavioral Health | 8080 Opal Cir, Anchorage, AK 99502-4542 | 2018-01-04 |
| 1497272470 | David Root | Community/Behavioral Health | 207 E Northern Lights Blvd Ste 212, Anchorage, AK 99503-2731 | 2017-08-29 |
| 1306393012 | Deon Burns | Community/Behavioral Health | 12725 Landmark St Apt B, Anchorage, AK 99515-3818 | 2016-09-10 |
| 1386199339 | Pcr Alaska LLC | Community/Behavioral Health | 1413 W 31st Ave, Anchorage, AK 99503-3624 | 2016-08-19 |
| Find all providers in ANCHORAGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.