Basic Information
Provider Information
NPI: 1285731950
EntityType: 2
ReplacementNPI:  
OrganizationName: ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES
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Mailing Information
Address1: 4045 LAKE OTIS PKWY
Address2: STE 101
City: ANCHORAGE
State: AK
PostalCode: 995085211
CountryCode: US
TelephoneNumber: 9075610954
FaxNumber: 9075617093
Practice Location
Address1: 4045 LAKE OTIS PKWY
Address2: STE 101
City: ANCHORAGE
State: AK
PostalCode: 995085211
CountryCode: US
TelephoneNumber: 9075615094
FaxNumber: 9075617093
Other Information
ProviderEnumerationDate: 09/17/2006
LastUpdateDate: 06/17/2008
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AuthorizedOfficialLastName: JENKINS
AuthorizedOfficialFirstName: JERRY
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AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 9075610954
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP1600X101YP1600XAKY193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorPastoral

No ID Information.


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