Basic Information
| Provider Information | |||||||||
| NPI: | 1407030026 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANCHORAGE NEIGHBORHOOD HEALTH CENTER INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4951 BUSINESS PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995037174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077437200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4951 BUSINESS PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995037174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077437200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOWLER | ||||||||
| AuthorizedOfficialFirstName: | VADETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9077437321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 1003895 | 05 | AK | MEDICAID |