Healthcare Provider Details

I. General information

NPI: 1154207900
Provider Name (Legal Business Name): POLAR STAR PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W DIMOND BLVD
ANCHORAGE AK
99515-1515
US

IV. Provider business mailing address

6833 S DAYTON ST # 104
GREENWOOD VILLAGE CO
80112-3624
US

V. Phone/Fax

Practice location:
  • Phone: 720-743-5627
  • Fax: 720-647-0194
Mailing address:
  • Phone: 918-636-7230
  • Fax: 720-647-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMERICA KARINA GOMEZ
Title or Position: PSYCHIATRY MENTAL HEALTH NURSE P.
Credential: PMHNP
Phone: 720-743-5627