Healthcare Provider Details

I. General information

NPI: 1104951615
Provider Name (Legal Business Name): RAILBELT MENTAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 EAST 2ND STREET
NENANA AK
99760
US

IV. Provider business mailing address

PO BOX 159 207 E. 2ND ST.
NENANA AK
99760-0159
US

V. Phone/Fax

Practice location:
  • Phone: 907-832-5557
  • Fax:
Mailing address:
  • Phone: 907-832-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number726807
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number726807
License Number StateAK

VIII. Authorized Official

Name: TRACI BOSCHERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-832-5557