Provider Demographics
NPI:1003176348
Name:ALASKA FAITH MINISTRIES LLC
Entity Type:Organization
Organization Name:ALASKA FAITH MINISTRIES LLC
Other - Org Name:NORTH COUNTRY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-822-5686
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0589
Mailing Address - Country:US
Mailing Address - Phone:907-822-3203
Mailing Address - Fax:907-822-5805
Practice Address - Street 1:53 MILE TOK CUTOFF
Practice Address - Street 2:
Practice Address - City:GAKONA
Practice Address - State:AK
Practice Address - Zip Code:99586-9702
Practice Address - Country:US
Practice Address - Phone:907-822-3937
Practice Address - Fax:907-822-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1037992261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1666871Medicaid
AKK0000WCHWPMedicare PIN
AK021821Medicare UPIN