Healthcare Provider Details

I. General information

NPI: 1205097862
Provider Name (Legal Business Name): VALDEZ SENIOR CITIZEN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E HANAGITA
VALDEZ AK
99686-1300
US

IV. Provider business mailing address

1300 E HANAGITA
VALDEZ AK
99686
US

V. Phone/Fax

Practice location:
  • Phone: 907-835-5032
  • Fax:
Mailing address:
  • Phone: 907-835-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: SHARON GAIL KESSE
Title or Position: PROGRAM MANGER
Credential: BHS
Phone: 907-835-5032