Organization
THE ALASKA SHIELD AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA BRADLEY (OWNER)
(907) 258-5665
Entity
Organization
Contact information
Practice address
11487 NIKOLAI CIRCLE, WASILLA, AK 99654-8801
(907) 258-5665
Mailing address
HC 35 BOX 5475A, WASILLA, AK 99654-8801
(907) 258-5665
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
723449
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMG678
DIVISION OF SENIOR AND DISABLED SERVICES
AK
Enumeration date
12/12/2008
Last updated
12/12/2008
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