Provider Demographics
NPI:1407224793
Name:AK CARE COORDINATION SERVICES LLC
Entity Type:Organization
Organization Name:AK CARE COORDINATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-252-4661
Mailing Address - Street 1:35477 KENAI SPUR HWY STE 217
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7644
Mailing Address - Country:US
Mailing Address - Phone:907-252-4661
Mailing Address - Fax:907-262-0431
Practice Address - Street 1:35477 KENAI SPUR HWY STE 217
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7644
Practice Address - Country:US
Practice Address - Phone:907-252-4661
Practice Address - Fax:907-262-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1018485251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1572032Medicaid