1902169253 NPI number — THE SALVATION ARMY

Table of content: (NPI 1902169253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902169253 NPI number — THE SALVATION ARMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SALVATION ARMY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BOOTH MEMORIAL YOUTH & FAMILY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902169253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 9TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99501-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-375-3505
Provider Business Mailing Address Fax Number:
907-279-0522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 E 20TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-375-3505
Provider Business Practice Location Address Fax Number:
907-279-0522
Provider Enumeration Date:
06/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
EGGLESTON
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
907-375-3505

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3245S0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3245S0500X , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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