Organization
PROVIDENCE KODIAK ISLAND COUNSELING CENTER
Active
Parent organization
PROVIDENCE HEALTH AND SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH AND SERVICES
Authorized official
MRS. VERONICA SAMANIEGO BA (CASE MNANAGER)
(907) 481-2400
Entity
Organization
Contact information
Practice address
717 E REZANOF DR, KODIAK, AK 99615-6416
(907) 481-2400
(907) 481-2419
Mailing address
717 E REZANOF DR, KODIAK, AK 99615-6416
(907) 481-2400
(907) 481-2419
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
920162237
AK
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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