MEDICARE: PROVIDENCE HEALTH & SERVICES-WASHINGTON

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	279763	AK
2	385H00000X	Respite Care	279763	AK
3	310400000X	Assisted Living Facility	279763	AK

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

NPI Number	:	1952323859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES-WASHINGTON

Provider Business Mailing Address
First Line	:	4140 FOLKER ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5323
Country	:	US
Telephone Number	:	907-261-4140
Fax Number	:	907-261-4160

Provider Business Practice Location Address
First Line	:	3760 PIPER ST
Second Line	:	SUITE 1061
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4683
Country	:	US
Telephone Number	:	907-212-0256
Fax Number	:	907-212-6547

Authorized Official
Title or Position	:	INTERIM DIRECTOR
Name	:	MRS. THERESA MARIE GLEASON
Credential	:	RN
Telephone Number	:	907-261-4167

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/21/2014

3760 PIPER ST STE 1108
ANCHORAGE, AK
99508-4683

Practice Phone: 907-212-6970
Practice Fax: