Healthcare Provider Details

I. General information

NPI: 1750409660
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 GLACIER HWY
JUNEAU AK
99801-7804
US

IV. Provider business mailing address

1803 GLACIER HWY
JUNEAU AK
99801-7804
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-6149
  • Fax:
Mailing address:
  • Phone: 907-463-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierHC2653
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
Identifier1004615
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: JENNIFER CARSON
Title or Position: HHCJ ADMINISTRATOR
Credential:
Phone: 907-463-6162