Provider Demographics
NPI:1093939548
Name:HOONAH BHVRL HLTH PROGRAM
Entity Type:Organization
Organization Name:HOONAH BHVRL HLTH PROGRAM
Other - Org Name:HOONAH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-945-3235
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:HOONAH
Mailing Address - State:AK
Mailing Address - Zip Code:99829-0103
Mailing Address - Country:US
Mailing Address - Phone:907-945-3235
Mailing Address - Fax:907-945-3239
Practice Address - Street 1:568 RAVIN DRIVE
Practice Address - Street 2:
Practice Address - City:HOONAH
Practice Address - State:AK
Practice Address - Zip Code:99829-0103
Practice Address - Country:US
Practice Address - Phone:907-945-3235
Practice Address - Fax:907-945-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH9829Medicaid
AKDA0129Medicaid