Organization
BRISTOL BAY AREA HEALTH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY LEEANN TAYLOR (PROVIDER ENROLLMENT SPECIALIST)
(907) 842-5201
Entity
Organization
Contact information
Practice address
36 ALDER DR., CHIGNIK LAKE, AK 99548-0036
(907) 845-2236
(907) 845-2353
Mailing address
P.O. BOX 36, CHIGNIK LAKE, AK 99548
(907) 845-2236
(907) 845-2353
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114050911
—
AK
Enumeration date
10/10/2012
Last updated
04/30/2021
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