Healthcare Provider Details

I. General information

NPI: 1093010209
Provider Name (Legal Business Name): WASHINGTON VOCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 E NORTHERN LIGHTS BLVD STE 108
ANCHORAGE AK
99508-4140
US

IV. Provider business mailing address

22316 70TH AVE W STE D
MOUNTLAKE TERRACE WA
98043-2184
US

V. Phone/Fax

Practice location:
  • Phone: 907-306-7258
  • Fax: 907-344-7284
Mailing address:
  • Phone: 425-774-3338
  • Fax: 425-744-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name: LYNN VAN VACTOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 425-320-7574