Provider Demographics
NPI:1699311894
Name:VOLUNTEERS OF AMERICA ALASKA, ASSIST 1115
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA ALASKA, ASSIST 1115
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QA AND RCM
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-279-9627
Mailing Address - Street 1:2600 CORDOVA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2745
Mailing Address - Country:US
Mailing Address - Phone:907-279-9627
Mailing Address - Fax:844-333-1920
Practice Address - Street 1:2600 CORDOVA ST STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2745
Practice Address - Country:US
Practice Address - Phone:907-279-9627
Practice Address - Fax:844-333-1920
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUNTEERS OF AMERICA ALASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1698481Medicaid