| Copper River Native Association | |
|
Mp 111.5 Richardson Hwy Copper Center AK 99573-0508 | |
| (907) 822-5241 | |
| (907) 822-8801 |
| Full Name | Copper River Native Association |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | Mp 111.5 Richardson Hwy, Copper Center, Alaska |
| Authorized Official Name and Position | Nikki R Wiedlund (PATIENT FINANCIAL SERVICES MANAGER) |
| Authorized Official Contact | 9072066812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Copper River Native Association Po Box 383 Glennallen AK 99588-0383 Ph: (907) 822-5241 | Copper River Native Association Mp 111.5 Richardson Hwy Copper Center AK 99573-0508 Ph: (907) 822-5241 |
| NPI Number | 1194866871 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194866871 | NPI | - | NPPES |
| DA4434 | Medicaid | AK | |
| MH0641 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 36087 (Alaska) | Primary |