Healthcare Provider Details

I. General information

NPI: 1841772795
Provider Name (Legal Business Name): CORDOVA SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SECOND AVENUE
CORDOVA AK
99574-1330
US

IV. Provider business mailing address

PO BOX 1330
CORDOVA AK
99574-1330
US

V. Phone/Fax

Practice location:
  • Phone: 907-424-3236
  • Fax: 907-424-3117
Mailing address:
  • Phone: 907-424-3265
  • Fax: 844-413-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALEX RUSSIN
Title or Position: SUPERINTENDENT
Credential:
Phone: 907-424-3265