1356551063 NPI number — TOK AREA MENTAL HEALTH COUNCIL, INC.

Table of content: (NPI 1356551063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356551063 NPI number — TOK AREA MENTAL HEALTH COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOK AREA MENTAL HEALTH COUNCIL, INC.
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:
1356551063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 398
Provider Second Line Business Mailing Address:
W.1ST ST SUITE 8
Provider Business Mailing Address City Name:
TOK
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99780-0398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-883-5106
Provider Business Mailing Address Fax Number:
907-883-5108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W.1ST STREET
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
TOK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99780-0398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-883-5106
Provider Business Practice Location Address Fax Number:
907-883-5108
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOWERY
Authorized Official First Name:
ORA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTORS
Authorized Official Telephone Number:
907-883-5855

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  183290 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 183290 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 183290 , 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: MH0285 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: TAM84686 . This is a "STATE OF AK VENDOR ID #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 183290 . This is a "ALASKA BUSINESS LICENSE #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 20456D . This is a "DCCED CBPL AK ENTITY #" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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