PROVIDENCE HEALTH & SERVICES WASHINGTON (NPI# 1841814795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841814795 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES WASHINGTON |
| Practice Address |
3200 Providence Dr Anchorage AK 99508-4615 |
| Mailing Address |
Po Box 4105 Portland OR 97208-4105 |
| Practice Telephone | 9072126002 |
| Practice Fax Number | 9072128340 |
| Mailing Telephone | 8669071068 |
| Mailing Fax Number | 4259179141 |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (ASSISTANT 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 MEDICAL GROUP ALASKA | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134656135 | Providence Health & Services Washington | Clinic/Center | 1018 Capitol Way S Ste 300, Olympia, WA 98501-1212 | 2017-05-22 |
| 1023550050 | Providence Health & Services Washington | Psychologist | 225 State Ave Ne, Olympia, WA 98501-6951 | 2016-11-08 |
| 1003367863 | Providence Health & Services Washington | Radiology | 4800 College St Se Ste E, Lacey, WA 98503-4389 | 2016-10-17 |
| 1023563897 | Providence Health & Services Washington | Clinic/Center | 1705 Se Meadowbrook Blvd, Suite 2, College Place, WA 99324-1756 | 2016-08-22 |
| 1457721250 | Providence Health & Services Washington | Clinic/Center | 1200 Basich Blvd, Aberdeen, WA 98520-1035 | 2015-10-06 |
| 1902141500 | Providence Health & Services Washington | Clinical Medical Laboratory | 820 S Mcclellan St Ste Ll10, Spokane, WA 99204-2446 | 2012-12-07 |
| 1881907715 | Providence Health & Services Washington | Internal Medicine | 62 W 7th Ave, Spokane, WA 99204-2321 | 2010-07-20 |
| 1073744850 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 2505 Olympic Hwy N., Ste 140, Shelton, WA 98584-2978 | 2009-07-28 |
| 1770714693 | Providence Health & Services Washington | Rehabilitation, Substance Use Disorder Unit | 508 1/2 Eighth Street, Hoquiam, WA 98550-3521 | 2009-07-28 |
| 1033309604 | Providence Health & Services Washington | Family Medicine | 1450 Northwest Lane Se, Lacey, WA 98503-6908 | 2007-07-30 |
| Street Address |
3200 PROVIDENCE DR |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99508-4615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902809429 | James M Moran | Pharmacist | 3200 Providence Dr, Anchorage, AK 99508-4661 | 2005-05-30 |
| 1104425073 | Lennett Lerch | Registered Nurse | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2020-10-21 |
| 1013521145 | Liberty Ann Helgeson | Registered Nurse | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2020-09-05 |
| 1245840651 | Andrew Zwerlein | Pharmacist | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2020-08-01 |
| 1417572090 | Jordan Iverson | Registered Nurse | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2020-06-10 |
| 1609490762 | Ellen Reeder | Nurse Practitioner | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2020-06-04 |
| 1265061279 | Providence Health & Services Washington | Clinic/Center | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2020-04-02 |
| 1437794138 | Haley Monolopolus | Pharmacist | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2019-11-17 |
| 1144707373 | Traci Sickich | Nurse Practitioner | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2018-07-20 |
| 1639666134 | Jennifer Elizabeth Aist | Lactation Consultant, Non-RN | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2018-04-19 |
| 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.