Provider Demographics
NPI:1093821373
Name:CATHOLIC COMMUNITY SERVICE INC
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICE INC
Other - Org Name:HOSPICE & HOMECARE OF JUNEAU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HHCJ/COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-6162
Mailing Address - Street 1:1803 GLACIER HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7804
Mailing Address - Country:US
Mailing Address - Phone:907-463-6149
Mailing Address - Fax:907-586-9018
Practice Address - Street 1:1803 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7804
Practice Address - Country:US
Practice Address - Phone:907-463-6111
Practice Address - Fax:888-626-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1005165Medicaid
AK1005501Medicaid
AKHP6543Medicaid
AKHH0378Medicaid
AKHP6543Medicaid