Provider Demographics
NPI:1417539693
Name:BRISTOL BAY AREA HEALTH CORPORATION
Entity Type:Organization
Organization Name:BRISTOL BAY AREA HEALTH CORPORATION
Other - Org Name:BRISTOL BAY COUNSELING CENTER GOODNEWS BAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-842-5201
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:907-842-9250
Practice Address - Street 1:155 CLINIC ROAD
Practice Address - Street 2:
Practice Address - City:GOODNEWS BAY
Practice Address - State:AK
Practice Address - Zip Code:99589
Practice Address - Country:US
Practice Address - Phone:907-842-1230
Practice Address - Fax:907-842-5174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRISTOL BAY AREA HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-27
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health