Healthcare Provider Details

I. General information

NPI: 1548972748
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA ALASKA, CREEKSIDE PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 E 6TH AVE
ANCHORAGE AK
99504-1941
US

IV. Provider business mailing address

2600 CORDOVA ST STE 101
ANCHORAGE AK
99503-2745
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-9640
  • Fax:
Mailing address:
  • Phone: 219-850-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MORA
Title or Position: RCM DIRECTOR
Credential:
Phone: 219-850-4084