MEDICARE: PIMHA TREATMENT CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106S00000X	Behavior Technician
3	251B00000X	Case Management Agency
4	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457022956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIMHA TREATMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	500 E TUDOR RD STE 202
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7377
Country	:	US
Telephone Number	:	907-519-2944
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E TUDOR RD STE 202
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7377
Country	:	US
Telephone Number	:	907-917-7298
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRIANA PILI
Credential	:
Telephone Number	:	907-519-2944

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/14/2022

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