Organization
MANIILAQ ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLIE BETH HAAS LPN (ELDER SERVICES DIRECTOR)
(907) 442-7917
Entity
Organization
Contact information
Practice address
607 WOLVERINE DRIVE, BOX 1073, KOTZEBUE, AK 99752-1073
(907) 442-7917
(907) 442-7932
Mailing address
607 WOLVERINE DRIVE, BOX 1073, KOTZEBUE, AK 99752-1073
(907) 442-7917
(907) 442-7932
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HC3590
AK
332U00000X
Home Delivered Meals
HC3590
AK
343900000X
Non-emergency Medical Transport (VAN)
HC3590
AK
385H00000X
Respite Care
HC3590
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HC3590
DSDS CERTIFICATION
AK
05
—
HC3590
—
AK
Enumeration date
07/22/2008
Last updated
07/22/2008
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