Healthcare Provider Details

I. General information

NPI: 1457022956
Provider Name (Legal Business Name): PIMHA TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E TUDOR RD STE 202
ANCHORAGE AK
99503-7377
US

IV. Provider business mailing address

500 E TUDOR RD STE 202
ANCHORAGE AK
99503-7377
US

V. Phone/Fax

Practice location:
  • Phone: 907-917-7298
  • Fax:
Mailing address:
  • Phone: 907-519-2944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIANA PILI
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-519-2944