Provider Demographics
NPI:1376766485
Name:THE SALVATION ARMY - SERENDIPITY
Entity Type:Organization
Organization Name:THE SALVATION ARMY - SERENDIPITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-339-3406
Mailing Address - Street 1:143 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3618
Mailing Address - Country:US
Mailing Address - Phone:907-339-3406
Mailing Address - Fax:907-276-2611
Practice Address - Street 1:3550 E 20TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3414
Practice Address - Country:US
Practice Address - Phone:907-279-0501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11806261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC9508Medicaid