=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073307328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAGLE RIVER BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2025
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12812 OLD GLENN HWY STE C4
-----------------------------------------------------
City | EAGLE RIVER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99577-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-726-0378
-----------------------------------------------------
Fax | 907-726-0374
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 770870
-----------------------------------------------------
City | EAGLE RIVER
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99577-0870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-726-0378
-----------------------------------------------------
Fax | 907-726-0374
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CATHERINE HAESE
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 907-317-5883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------