Healthcare Provider Details

I. General information

NPI: 1255047635
Provider Name (Legal Business Name): ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 LAUREL ST
ANCHORAGE AK
99508-5392
US

IV. Provider business mailing address

4045 LAKE OTIS PKWY STE 209
ANCHORAGE AK
99508-5227
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY EVENSON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 907-261-5317