Provider Demographics
NPI:1174641146
Name:CATHOLIC COMMUNITY SERVICE
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICE
Other - Org Name:HOONAH SENIOR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-6163
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:907-463-6100
Mailing Address - Fax:907-586-9018
Practice Address - Street 1:610 DOUGLAS DRIVE
Practice Address - Street 2:
Practice Address - City:HOONAH
Practice Address - State:AK
Practice Address - Zip Code:99829-0353
Practice Address - Country:US
Practice Address - Phone:907-463-6149
Practice Address - Fax:907-586-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC2661Medicaid
AK1004618Medicaid