Healthcare Provider Details

I. General information

NPI: 1205623931
Provider Name (Legal Business Name): BETHESDA TREATMENT AND RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E NORTHERN LIGHTS BLVD
ANCHORAGE AK
99508-4219
US

IV. Provider business mailing address

1100 E NORTHERN LIGHTS BLVD
ANCHORAGE AK
99508-4219
US

V. Phone/Fax

Practice location:
  • Phone: 907-412-1128
  • Fax:
Mailing address:
  • Phone: 907-412-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDDY RUKEMA KANIKI
Title or Position: CEO
Credential: RPH
Phone: 907-412-1128