Healthcare Provider Details

I. General information

NPI: 1225151327
Provider Name (Legal Business Name): CITY OF VALDEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MEALS AVENUE
VALDEZ AK
99686
US

IV. Provider business mailing address

PO BOX 550
VALDEZ AK
99686-0550
US

V. Phone/Fax

Practice location:
  • Phone: 907-835-2838
  • Fax: 907-834-1890
Mailing address:
  • Phone: 907-835-2838
  • Fax: 907-834-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberNOT NUMBERED
License Number StateAK

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786