Provider Demographics
NPI:1184670499
Name:PROVIDENCE HEALTH SYSTEM - WASHINGTON
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH SYSTEM - WASHINGTON
Other - Org Name:PROVIDENCE CENTER FOR NEUROPSYCH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALINSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-743-2309
Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:SUITE 422
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4615
Mailing Address - Country:US
Mailing Address - Phone:907-212-2673
Mailing Address - Fax:907-561-5478
Practice Address - Street 1:3260 PROVIDENCE DR
Practice Address - Street 2:SUITE 422
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-212-2673
Practice Address - Fax:907-561-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2820542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK151755Medicare ID - Type Unspecified