Provider Demographics
NPI:1518503267
Name:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Entity Type:Organization
Organization Name:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALASKA DIVISION, SECRETARY FOR BUSI
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-339-3410
Mailing Address - Street 1:143 EAST 9TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-339-3410
Mailing Address - Fax:907-276-2611
Practice Address - Street 1:8000 WEST END ROAD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99519
Practice Address - Country:US
Practice Address - Phone:907-339-3410
Practice Address - Fax:907-276-2611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1696793Medicaid