| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 110 Lynch Street, Wrangell, Alaska |
| Authorized Official Name and Position | Daniel Harris (VP/CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 9074634000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3100 Channel Drive Ste 300 Attn: Provider Enrollment Juneau AK 99801 Ph: (907) 463-4000 | 110 Lynch Street Wrangell AK 99929 Ph: (907) 874-3375 |
| NPI Number | 1003352402 |
|---|---|
| Provider Enumeration Date | 01/10/2017 |
| Last Update Date | 01/20/2021 |
| Certification Date | 01/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003352402 | NPI | - | NPPES |
| 1666511 | Medicaid | AK | |
| 70206 | Other | AK | BUSINESS LICENSE |
| 1674341 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Alaska Island Community Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 Church Street, Wrangell, AK 99929 Phone: 907-874-2373 Fax: 907-874-2576 |