1861825887 NPI number — OLIVIA C MOSES BHA TRAINEE

Table of content: OLIVIA C MOSES BHA TRAINEE (NPI 1861825887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861825887 NPI number — OLIVIA C MOSES BHA TRAINEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSES
Provider First Name:
OLIVIA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BHA TRAINEE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORN-MOSES
Provider Other First Name:
OLIVIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861825887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMMONAK
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99581-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-949-3524
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
829 CHIEF EDDIE HOFFMAN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-543-6100
Provider Business Practice Location Address Fax Number:
907-543-6159
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , 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: MH0150 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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