Healthcare Provider Details

I. General information

NPI: 1871139071
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA ALASKA, ARCH 1115
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 STEWART MOUNTAIN DR
EAGLE RIVER AK
99577-9013
US

IV. Provider business mailing address

2600 CORDOVA ST STE 101
ANCHORAGE AK
99503-2745
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-9627
  • Fax: 844-333-1920
Mailing address:
  • Phone: 907-279-9627
  • Fax: 844-333-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MORA
Title or Position: DIRECTOR OF QA AND RCM
Credential:
Phone: 907-279-9627