The Salvation Army Booth Memorial Outpatient

Primary specialty

Social WorkerTaxonomy code 104100000X

License

11806 Issued in AK

Legal business name

THE SALVATION ARMY BOOTH MEMORIAL OUTPATIENT

Practice address

3600 E 20TH Ave
Anchorage, AK 99508-3416

Phone

(907) 279-0522

NPI assigned

Apr 12, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adelene M Kelly

Title

Divisional Finance Director

Phone

(907) 339-3406

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

The Salvation Army - Serendipity5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• The Salvation Army - Serendipity

  • Adult Day Care Clinic/Center
  • Anchorage, AK
  • NPI 1376766485
  NPD tax ID
• The Salvation Army Booth Memorial Cares for Kids Nursery

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Anchorage, AK
  • NPI 1326262890
  NPD tax ID
• The Salvation Army Booth Memorial Residential Childcare

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Anchorage, AK
  • NPI 1265656730
  NPD tax ID
• The Salvation Army Older Alaskans Program

  • Home Delivered Meals
  • Anchorage, AK
  • NPI 1386867315
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1023232808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 E 9TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995013618",
            "telephone_number": "907-339-3406",
            "fax_number": "907-276-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 E 20TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995083416",
            "telephone_number": "907-279-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SALVATION ARMY BOOTH MEMORIAL OUTPATIENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "ADELENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIVISIONAL FINANCE DIRECTOR",
        "authorized_official_telephone_number": "907-339-3406"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AK",
            "license": "11806",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AK",
            "license": "11806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA4468",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Premier Life of Anchorage
• The Recovery Zone/ Myobalance LLC
• The Salvation Army (Booth Memorial Youth & Family Services)
• The Salvation Army - Serendipity
• The Salvation Army Booth Memorial Cares for Kids Nursery
• The Salvation Army Booth Memorial Residential Childcare
• The Salvation Army Clitheroe Center
• The Salvation Army Clitheroe Center - Dual Diagnosis
• The Salvation Army Older Alaskans Program
• The Salvation Army, a California Corporation (Clitheroe Women's Residential Center)

• Social Worker in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Social Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.