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NPI Code Detail

MEDICARE: CODI, INC.

MEDICARE: CODI, INC.
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1205267473
Entity Type Code : Organization
Provider Name (Legal Business Name) : CODI, INC.
Provider Business Mailing Address
First Line : PO BOX 1907
Second Line :
City : PALMER
State : AK
Zip : 99645-1907
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11921 E PALMER WASILLA HWY
Second Line :
City : PALMER
State : AK
Zip : 99645-8833
Country : US
Telephone Number : 907-745-2634
Fax Number :
Authorized Official
Title or Position : PLL CLINICIAN
Name : LEE ANN MITCHELL
Credential : MS
Telephone Number : 907-745-2634
Provider Enumeration Date : 12/12/2013
Last Update Date : 12/12/2013

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Directions to “CODI, INC. ” Practice Location

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