Healthcare Provider Details

I. General information

NPI: 1649931296
Provider Name (Legal Business Name): COPPER RIVER NATIVE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE 111.5 RICHARDSON HIGHWAY
COPPER CENTER AK
99573
US

IV. Provider business mailing address

PO BOX H
COPPER CENTER AK
99573-0508
US

V. Phone/Fax

Practice location:
  • Phone: 907-822-5421
  • Fax:
Mailing address:
  • Phone: 907-822-5421
  • Fax: 907-531-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PRICE
Title or Position: MANAGER OF PFS
Credential:
Phone: 603-817-6252