Provider Demographics
NPI:1467445296
Name:CITY OF KETCHIKAN-GATEWAY CENTER FOR HUMAN SERVICES
Entity Type:Organization
Organization Name:CITY OF KETCHIKAN-GATEWAY CENTER FOR HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMYLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-225-3111
Mailing Address - Street 1:3050 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5773
Mailing Address - Country:US
Mailing Address - Phone:907-225-4135
Mailing Address - Fax:907-247-4135
Practice Address - Street 1:3050 5TH AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5773
Practice Address - Country:US
Practice Address - Phone:907-225-4135
Practice Address - Fax:907-247-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 103TC0700X, 1041C0700X
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
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDA7113Medicaid
AKDA4438Medicaid
AKMH0133Medicaid
AKDA7113Medicaid