Provider Demographics
NPI:1215167382
Name:PROVIDENCE HEALTH AND SERVICES ALASKA
Entity type:Organization
Organization Name:PROVIDENCE HEALTH AND SERVICES ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-212-0254
Mailing Address - Street 1:4900 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7446
Mailing Address - Country:US
Mailing Address - Phone:907-562-2281
Mailing Address - Fax:
Practice Address - Street 1:4900 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7446
Practice Address - Country:US
Practice Address - Phone:907-562-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1697314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility