MEDICARE: PETERSBURG BOROUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	00276	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023132784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERSBURG BOROUGH

Provider Business Mailing Address
First Line	:	PO BOX 1530
Second Line	:
City	:	PETERSBURG
State	:	AK
Zip	:	99833-1530
Country	:	US
Telephone Number	:	907-772-2445
Fax Number	:	907-772-2435

Provider Business Practice Location Address
First Line	:	16 NORTH 12TH STREET
Second Line	:
City	:	PETERSBURG
State	:	AK
Zip	:	99833-0000
Country	:	US
Telephone Number	:	907-772-3445
Fax Number	:	907-772-4217

Authorized Official
Title or Position	:	DIRECTOR/ADMINISTRATOR
Name	:	SHELYN MARIE BELL
Credential	:
Telephone Number	:	907-772-2445

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	12/29/2021

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Directions to “PETERSBURG BOROUGH ” Practice Location

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