1295407948 NPI number — CARE COORDINATION SERVICES OF ALASKA LLC

Table of content: (NPI 1295407948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295407948 NPI number — CARE COORDINATION SERVICES OF ALASKA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE COORDINATION SERVICES OF ALASKA LLC
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:
6
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:
1295407948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 671403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHUGIAK
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99567-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-301-0072
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24937 JESSE LEE COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHUGIAK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
190-730-1007
Provider Business Practice Location Address Fax Number:
822-409-2220
Provider Enumeration Date:
10/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER / ADMIISTRATOR
Authorized Official Telephone Number:
907-301-0072

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1716509 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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