1598347668 NPI number — BRISTOL BAY AREA HEALTH CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598347668 NPI number — BRISTOL BAY AREA HEALTH CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL BAY AREA HEALTH CORPORATION
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:
BRISTOL BAY COUNSELING CENTER CHIGNIK 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:
1598347668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DILLINGHAM
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99576-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-842-5201
Provider Business Mailing Address Fax Number:
907-842-9250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIGNIK BAY
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-842-1230
Provider Business Practice Location Address Fax Number:
907-842-5174
Provider Enumeration Date:
04/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
LEEANN
Authorized Official Title or Position:
PROVIDER ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
907-842-5201

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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