Healthcare Provider Details

I. General information

NPI: 1295407948
Provider Name (Legal Business Name): CARE COORDINATION SERVICES OF ALASKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24937 JESSE LEE COURT
CHUGIAK AK
99567
US

IV. Provider business mailing address

PO BOX 671403
CHUGIAK AK
99567-1403
US

V. Phone/Fax

Practice location:
  • Phone: 190-730-1007
  • Fax: 822-409-2220
Mailing address:
  • Phone: 907-301-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: STEVEN L SMITH
Title or Position: OWNER / ADMIISTRATOR
Credential:
Phone: 907-301-0072