Provider Demographics
NPI:1073125514
Name:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES INC.
Entity type:Organization
Organization Name:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-261-5317
Mailing Address - Street 1:4020 FOLKER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5321
Mailing Address - Country:US
Mailing Address - Phone:907-563-1000
Mailing Address - Fax:907-375-3142
Practice Address - Street 1:1432 INGRA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5434
Practice Address - Country:US
Practice Address - Phone:907-563-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020991Medicaid