Healthcare Provider Details

I. General information

NPI: 1124110796
Provider Name (Legal Business Name): PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E MARYDALE AVE
SOLDOTNA AK
99669-7648
US

IV. Provider business mailing address

PO BOX 2949
SOLDOTNA AK
99669-2949
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-3119
  • Fax: 907-262-9290
Mailing address:
  • Phone: 907-260-7303
  • Fax: 907-260-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN J WRIGHT
Title or Position: CEO
Credential:
Phone: 907-260-7314