1174792972 NPI number — COOK INLET COUNCIL ON ALCOHOL AND DRUG ABUSE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174792972 NPI number — COOK INLET COUNCIL ON ALCOHOL AND DRUG ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOK INLET COUNCIL ON ALCOHOL AND DRUG ABUSE
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:
Provider Other Organization Name Type Code:
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:
1174792972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 882
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENAI
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99611-0882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-283-3658
Provider Business Mailing Address Fax Number:
907-283-5046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10200 KENAI SPUR HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENAI
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99611-7807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-283-3658
Provider Business Practice Location Address Fax Number:
907-283-5046
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NOVAK
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
907-283-3658

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  261QR0405X , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1679796528 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1396897419 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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