Healthcare Provider Details

I. General information

NPI: 1245585934
Provider Name (Legal Business Name): ONC ADULT DAY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ATSAQ STREET 127 ATSAQ
BETHEL AK
99559-0927
US

IV. Provider business mailing address

127 ATSAQ STREET P.O. BOX 927
BETHEL AK
99559-0927
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-3988
  • Fax: 907-543-5787
Mailing address:
  • Phone: 907-543-3988
  • Fax: 907-543-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number974445
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number974445
License Number StateAK

VIII. Authorized Official

Name: MS. LOUISE CHARLES
Title or Position: DIRECTOR
Credential:
Phone: 907-543-3988