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Contact Information

PROVIDENCE HEALTH & SERVICES WASHINGTON
1818 E REZANOF DR
KODIAK, AK99615-6505
 Phone: 907-481-2400
 Fax: 907-481-2419
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Behavioral Health

251S00000X
 

Addiction (Substance Use Disorder)

101YA0400X
 

Case Manager/Care Coordinator

171M00000X
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
Indicates primary specialty

NPI Profile & details for PROVIDENCE HEALTH & SERVICES WASHINGTON

NPI # 1477563344
LBN Legal business name PROVIDENCE HEALTH & SERVICES WASHINGTON
Authorized official DONALD ANDERSON - (ASSISTANT SECRETARY OF ENROLLMENTS)
Entity Organization
Organization subpart 1 No
Enumeration date 08/09/2006
Last updated 05/15/2025 - More than a year ago
Identifiers
AK License # 297340
AK Medicaid MH 2237 & DA2237
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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