Healthcare Provider Details

I. General information

NPI: 1710054093
Provider Name (Legal Business Name): CENTER FOR COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN ST SUITE B
SITKA AK
99835-7314
US

IV. Provider business mailing address

700 KATLIAN ST SUITE B
SITKA AK
99835-7314
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-6960
  • Fax: 907-747-4868
Mailing address:
  • Phone: 907-747-6960
  • Fax: 907-747-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CONNIE SIPE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-747-6960