MEDICARE: JULIA AGNES STREET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487068847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA AGNES STREET

Provider Business Mailing Address
First Line	:	PO BOX 528
Second Line	:	ATTN: BH FIT
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-3690
Fax Number	:	907-543-1276

Provider Business Practice Location Address
First Line	:	460 RIDGECREST DRIVE SUITE 215
Second Line	:
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-3690
Fax Number	:	907-543-1276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	04/12/2026

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Directions to “ JULIA AGNES STREET ” Practice Location

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