Organization
INDIVIDUALS FIRST CARE COORDINATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE SKUBE (ADMINISTRATOR/CARE COORDINATOR)
(907) 982-9343
Entity
Organization
Contact information
Practice address
2041 N BROADWAY DR, PALMER, AK 99645-9314
(907) 982-9343
(907) 746-8620
Mailing address
PO BOX 3545, PALMER, AK 99645-3545
(907) 982-9343
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
980370
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMX
SDS PROVIDER NUMBER
AK
05
—
COS 68
—
AK
Enumeration date
02/22/2013
Last updated
02/22/2013
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