MEDICARE: ANCHORAGE COMMUNITY MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023614468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHORAGE COMMUNITY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	4020 FOLKER ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5321
Country	:	US
Telephone Number	:	907-563-1000
Fax Number	:	907-375-3142

Provider Business Practice Location Address
First Line	:	3815 WILLIAMS ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4539
Country	:	US
Telephone Number	:	907-563-1000
Fax Number	:	907-375-3142

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ASHLEY EVENSON
Credential	:
Telephone Number	:	907-261-5317

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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