1518403906 NPI number — SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM

Table of content: (NPI 1518403906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518403906 NPI number — SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
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:
SEARHC EDNA BAY
Provider Other Organization Name Type Code:
3
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:
1518403906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 CHANNEL DRIVE STE 300
Provider Second Line Business Mailing Address:
ATTN: PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-463-4000
Provider Business Mailing Address Fax Number:
907-463-1510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUNRISE LODGE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDNA BAY
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-874-4700
Provider Business Practice Location Address Fax Number:
907-874-4719
Provider Enumeration Date:
01/10/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
907-463-4000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 70206 . This is a "BUSINESS LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com