Healthcare Provider Details

I. General information

NPI: 1306969647
Provider Name (Legal Business Name): NORTON SOUND HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AND DIVISION BHS
NOME AK
99762
US

IV. Provider business mailing address

5TH AND DIVISION PO BOX 966
NOME AK
99762
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3311
  • Fax: 907-443-6412
Mailing address:
  • Phone: 907-443-3311
  • Fax: 907-443-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberDA4488
License Number StateAK

VIII. Authorized Official

Name: ANGELA GORN
Title or Position: V P HOSPITAL SERVICES
Credential:
Phone: 907-443-3311