Healthcare Provider Details

I. General information

NPI: 1831319227
Provider Name (Legal Business Name): ALASKA ISLAND COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CHURCH STREET
WRANGELL AK
99929-1231
US

IV. Provider business mailing address

PO BOX 1231
WRANGELL AK
99929-1231
US

V. Phone/Fax

Practice location:
  • Phone: 907-874-2373
  • Fax: 907-874-2576
Mailing address:
  • Phone: 907-874-2373
  • Fax: 907-874-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARK WALKER
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 907-874-2373