Provider Demographics
NPI:1982328449
Name:ANIRTURVIK TREATMENT SERVICES
Entity Type:Organization
Organization Name:ANIRTURVIK TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, MAC, QAP
Authorized Official - Phone:907-671-1885
Mailing Address - Street 1:8158 W TIA TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0378
Mailing Address - Country:US
Mailing Address - Phone:907-671-1885
Mailing Address - Fax:
Practice Address - Street 1:5960 W HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0516
Practice Address - Country:US
Practice Address - Phone:907-671-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service