Organization
BRISTOL BAY AREA HEALTH CORPORATION
Active
Other names
JAKE'S PLACE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J CLARK (CHIEF EXECUTIVE OFFICER)
(907) 842-5201
Entity
Organization
Contact information
Practice address
6000 KANAKANAK ROAD, DILLINGHAM, AK 99576-0130
(907) 842-5201
(907) 842-9250
Mailing address
PO BOX 130, DILLINGHAM, AK 99576-0130
(904) 842-5201
(904) 842-9250
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA4432
—
AK
Enumeration date
03/13/2007
Last updated
04/04/2013
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