Healthcare Provider Details

I. General information

NPI: 1346791746
Provider Name (Legal Business Name): AKEELA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 FRONTAGE RD STE 200B
KENAI AK
99611-9122
US

IV. Provider business mailing address

360 W BENSON BLVD STE 300
ANCHORAGE AK
99503-3953
US

V. Phone/Fax

Practice location:
  • Phone: 907-283-6586
  • Fax: 907-283-4029
Mailing address:
  • Phone: 907-565-1200
  • Fax: 907-258-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number274070
License Number StateAK

VIII. Authorized Official

Name: COURTNEY DONOVAN
Title or Position: CEO
Credential: PHD
Phone: 907-433-7040