Healthcare Provider Details

I. General information

NPI: 1134247042
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: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 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: 907-463-6149
  • Fax: 888-592-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHEMA JONES
Title or Position: CFO
Credential:
Phone: 907-463-6143