Provider Demographics
NPI:1447661301
Name:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE/CLINICAL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:ZORA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LESUEUR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-561-5309
Mailing Address - Street 1:4020 FOLKER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5321
Mailing Address - Country:US
Mailing Address - Phone:907-261-5309
Mailing Address - Fax:
Practice Address - Street 1:4020 FOLKER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5321
Practice Address - Country:US
Practice Address - Phone:907-261-5309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6990261QC1500X, 261QM0801X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK574943789Medicaid
574943789Medicare PIN