Healthcare Provider Details

I. General information

NPI: 1003176348
Provider Name (Legal Business Name): ALASKA FAITH MINISTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 MILE TOK CUTOFF
GAKONA AK
99586-9702
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-822-3937
  • Fax: 907-822-3937
Mailing address:
  • Phone: 907-822-3203
  • Fax: 907-822-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1037992
License Number StateAK

VIII. Authorized Official

Name: STEVEN GALLAGHER
Title or Position: CEO
Credential:
Phone: 907-822-5686