Provider Demographics
NPI:1285731950
Name:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-561-0954
Mailing Address - Street 1:4045 LAKE OTIS PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5211
Mailing Address - Country:US
Mailing Address - Phone:907-561-0954
Mailing Address - Fax:907-561-7093
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:STE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5211
Practice Address - Country:US
Practice Address - Phone:907-561-5094
Practice Address - Fax:907-561-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YP1600X101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty