NPIMap

Organization Active NPI

Providence Health & Services - Washington

Doing business as Providence Adolescent Residential Treatment Program

  • Psychiatric Residential Treatment Facility
  • Anchorage, AK
National Provider Identifier
1659483113
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
400157 Issued in AK
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Doing business as
Providence Adolescent Residential Treatment Program
Practice address
3210 W 62ND Ave
Anchorage, AK 99502
Phone
(907) 212-2040
Fax
(907) 272-2169
NPI assigned
Aug 31, 2006
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Donald W. Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 400157 AK Primary

Addresses

Primary practice location

3210 W 62ND Ave
Anchorage, AK 99502

Mailing address

3760 Piper St
Suite 1061
Anchorage, AK 99508-4665
Phone (907) 212-0209

Other identifiers 1

IdentifierTypeStateIssuer
HS487PIMedicaidAK

Other names 1

  • Providence Adolescent Residential Treatment Program Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1659483113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 PIPER ST",
            "address_2": "SUITE 1061",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084665",
            "telephone_number": "907-212-0209",
            "fax_number": "907-212-6547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 W 62ND AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99502",
            "telephone_number": "907-212-2040",
            "fax_number": "907-272-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES - WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "AK",
            "license": "400157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS487PI",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Adolescent Residential Treatment Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.