Healthcare Provider Details

I. General information

NPI: 1073169793
Provider Name (Legal Business Name): PATHFINDER CARE COORDINATION CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S TIMBERLINE CIR
WASILLA AK
99654-8750
US

IV. Provider business mailing address

PO BOX 879349
WASILLA AK
99687-9349
US

V. Phone/Fax

Practice location:
  • Phone: 907-232-9490
  • Fax: 888-865-5534
Mailing address:
  • Phone: 907-521-1588
  • Fax: 888-865-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1697739
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: MRS. REBECCA RACENET
Title or Position: PRESIDENT
Credential: CARE COORDINATOR
Phone: 907-521-1588