Healthcare Provider Details

I. General information

NPI: 1962625939
Provider Name (Legal Business Name): NOME COMMUNITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WEST 3RD AVENUE
NOME AK
99762
US

IV. Provider business mailing address

P.O. BOX 98
NOME AK
99762-0098
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-5259
  • Fax: 907-443-2990
Mailing address:
  • Phone: 907-443-5259
  • Fax: 907-443-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberHC9475
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License NumberHC9475
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number60313008
License Number StateAK

VIII. Authorized Official

Name: DANIELLE SLINGSBY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-443-5259