Healthcare Provider Details

I. General information

NPI: 1922436732
Provider Name (Legal Business Name): JC FAITH OPEN ARMS 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 STATE ST UNIT A
ANCHORAGE AK
99504-2038
US

IV. Provider business mailing address

PO BOX 212671
ANCHORAGE AK
99521-2671
US

V. Phone/Fax

Practice location:
  • Phone: 907-332-4730
  • Fax: 907-332-4737
Mailing address:
  • Phone: 907-602-0818
  • Fax: 907-332-4737

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: JOYCE MEWBORN
Title or Position: OWNER
Credential:
Phone: 907-602-0818