Healthcare Provider Details

I. General information

NPI: 1538389598
Provider Name (Legal Business Name): ANCHORAGE COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 FOLKER ST
ANCHORAGE AK
99508-5321
US

IV. Provider business mailing address

4020 FOLKER ST
ANCHORAGE AK
99508-5321
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1000
  • Fax: 907-770-8917
Mailing address:
  • Phone: 907-563-1000
  • Fax: 907-770-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JERRY A. JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential: MED., MAC
Phone: 907-261-5310