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General NPI Number Information
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NPI Number | 1689021412
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Entity Type | Organization
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Legal Business Name | AK HIPPIE CHIC SERVICES
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | MILE 2 KALIFORNSKY BEACH ROAD
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City | KASILOF
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State | AK
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Zip | 99610-0392
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Country | US
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Telephone | 907-690-4469
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Fax | 907-782-4145
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | KASILOF
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State | AK
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Zip | 99610-0392
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Country | US
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Telephone | 907-690-4469
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Fax | 907-782-4145
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Authorized Official
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Title or Position | OWNER/OPERATOR/ADMINISTRATOR
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Name | MS. LEE ANNE CRAFTON
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Credential |
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Telephone | 907-690-4469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1574944
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License Number State | AK
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