NPIMap

Organization Active NPI

City of Valdez

Doing business as Providence Valdez Medical Center

  • Skilled Nursing Facility
  • Valdez, AK
National Provider Identifier
1790715928
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NOT NUMBERED Issued in AK
Legal business name
CITY OF VALDEZ
Doing business as
Providence Valdez Medical Center
Practice address
911 Meals Avenue
Valdez, AK 99686
Phone
(907) 835-2249
Fax
(907) 834-1890
NPI assigned
Jul 4, 2006
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CITY OF VALDEZAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NOT NUMBERED AK Primary

Addresses

Primary practice location

911 Meals Avenue
Valdez, AK 99686

Mailing address

PO Box 550
Valdez, AK 99686-0550
Phone (907) 835-2249

Other identifiers 1

IdentifierTypeStateIssuer
LT2123MedicaidAK

Other names 1

  • PROVIDENCE VALDEZ MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121108000601 AK Part A Provider - Skilled Nursing Facility 3577514694 Practice locations: Valdez, AK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790715928. Details of each certification follow.

Skilled nursing facility certification: CCN 025034

Legal name
CITY OF VALDEZ
Doing business as
PROVIDENCE VALDEZ MEDICAL CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 3, 2005
Last certification
Mar 6, 2025
Beds
10
Ownership / control type
City
Organization structure
OtherNon-profit
Incorporated
Jun 11, 1901 in AK
Enrollment address
911 Meals Ave
Valdez, AK 99686
Nursing home name
PROVIDENCE VALDEZ MEDICAL CENTER
Affiliated entity
PROVIDENCE HEALTH & SERVICES

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

  • City of Valdez

    dba Providence Valdez Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Valdez, AK
    • NPI 1336247824

    3577514694

    Same PAC ID
  • City of Valdez

    dba Providence Valdez Medical Center

    • Critical Access Hospital Clinic/Center
    • Valdez, AK
    • NPI 1427424282

    3577514694

    Same PAC ID
  • City of Valdez

    dba Providence Valdez Medical Center

    • Critical Access Hospital
    • Valdez, AK
    • NPI 1750485488

    3577514694

    Same PAC ID

Care Compare: Nursing home

Medicare Care Compare
Listed as
Providence Valdez Medical CenterCCN 025034 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - City
Certified
Oct 3, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
108.9 residents per day on average
Chain
Providence Health & Services8 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
City of Valdez3 organizations share this tax ID, including this one
Part of
City of Valdez

Other organizations with this tax ID 2

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

  • City of Valdez

    dba Providence Valdez Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Valdez, AK
    • NPI 1336247824
    NPD tax ID
  • City of Valdez

    dba Providence Valdez Medical Center

    • Critical Access Hospital
    • Valdez, AK
    • NPI 1750485488
    NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

911 Meals Ave
Valdez, AK 99686
Phone (907) 835-2249

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pauline Doucet Individual Operational/Managerial Control Jan 1, 2005
Adp of the SNF May 29, 2025
Mary Beth Formby Individual Operational/Managerial Control Nov 12, 2025
Providence Health & Services - Washington Organization, Renton, WA Non-profit, Chain home office Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jun 30, 2025
Nathan Duval Individual Operational/Managerial Control May 6, 2025
Adp of the SNF May 6, 2025
City of Valdez Organization, Valdez, AK 5% Or Greater Direct Ownership Interest Jan 1, 2005 100%
Adp of the SNF Jan 1, 2005
James Martin Individual Corporate OfficerAssistant Treasurer Jan 13, 2023
Operational/Managerial Control Jan 13, 2023
Adp of the SNF Jan 13, 2023
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Jan 1, 2017
Operational/Managerial Control Jan 1, 2017
Adp of the SNF Jan 1, 2017
Gregory David Hoffman Individual Operational/Managerial Control Oct 1, 2020
Adp of the SNF Oct 1, 2020
Kathleen G Todd Individual Operational/Managerial Control Jun 5, 2023
Adp of the SNF Jun 5, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1790715928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550",
            "city": "VALDEZ",
            "state": "AK",
            "postal_code": "996860550",
            "telephone_number": "907-835-2249",
            "fax_number": "907-834-1890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 MEALS AVENUE",
            "city": "VALDEZ",
            "state": "AK",
            "postal_code": "99686",
            "telephone_number": "907-835-2249",
            "fax_number": "907-834-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF VALDEZ",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITY OF VALDEZ",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AK",
            "license": "NOT NUMBERED",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LT2123",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVIDENCE VALDEZ MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdez, AK

Sources for this page

Verify at the official NPI Registry.