Organization
RURAL CAP ALASKA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA GOMEZ-VILLANUEVA RSS (CASE MANAGER)
(907) 222-5259
Entity
Organization
Contact information
Practice address
120 N HOYT ST, ANCHORAGE, AK 99508-1602
(907) 222-5259
Mailing address
120 N HOYT ST, ANCHORAGE, AK 99508-1602
(907) 222-5259
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
5890375920
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9567840
—
AK
Enumeration date
06/21/2013
Last updated
06/21/2013
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