Healthcare Provider Details

I. General information

NPI: 1952595167
Provider Name (Legal Business Name): NORTON SOUND HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WEST 5TH AVENUE
NOME AK
99762
US

IV. Provider business mailing address

711 EAST 3RD AVENUE
NOME AK
99762
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3344
  • Fax: 907-443-5915
Mailing address:
  • Phone: 907-443-4576
  • Fax: 907-443-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberAK100247
License Number StateAK

VIII. Authorized Official

Name: GREGORY SMITH
Title or Position: CLINICAL CARE COORDINATOR
Credential: LCSW
Phone: 907-443-3344