1457610230 NPI number — HELENA MARY LOIS BOCK COMMUNITY HEALTH AID

Table of content: HELENA MARY LOIS BOCK COMMUNITY HEALTH AID (NPI 1457610230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457610230 NPI number — HELENA MARY LOIS BOCK COMMUNITY HEALTH AID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOCK
Provider First Name:
HELENA
Provider Middle Name:
MARY LOIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
COMMUNITY HEALTH AID
Provider Gender Code:
F

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:
1457610230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15765 KINGSLEY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NINILCHIK
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99639-9368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-567-3970
Provider Business Mailing Address Fax Number:
907-567-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15765 KINGSLEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINILCHIK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99639-9368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-567-3970
Provider Business Practice Location Address Fax Number:
907-567-3902
Provider Enumeration Date:
05/14/2012

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: 261QC1500X , with the licence number:  99-206-IV , 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)





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