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Organization
KENAI PENINSULA COMMUNITY CARE SO
Active
Organization
KENAI PENINSULA COMMUNITY CARE SO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA BIDWELL BA IN PSYCHOLOGY (EXECUTIVE DIRECTOR)
(907) 283-7635
Entity
Organization
Contact information
Practice address
320 S SPRUCE ST, KENAI, AK 99611-7939
(907) 283-7635
(907) 283-9575
Mailing address
320 S SPRUCE ST, KENAI, AK 99611-7939
(907) 283-7635
(907) 283-9575
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH6326
—
AK
Enumeration date
07/19/2013
Last updated
07/19/2013
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