Provider Demographics
NPI:1295407948
Name:CARE COORDINATION SERVICES OF ALASKA LLC
Entity Type:Organization
Organization Name:CARE COORDINATION SERVICES OF ALASKA LLC
Other - Org Name:CARE COORDINATION SERVICES OF ALASKA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMIISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-301-0072
Mailing Address - Street 1:PO BOX 671403
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-1403
Mailing Address - Country:US
Mailing Address - Phone:907-301-0072
Mailing Address - Fax:
Practice Address - Street 1:24937 JESSE LEE COURT
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:190-730-1007
Practice Address - Fax:822-409-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1716509Medicaid