Provider Demographics
NPI:1508217316
Name:KACHEMAK CARE COORDINATION
Entity Type:Organization
Organization Name:KACHEMAK CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-399-2500
Mailing Address - Street 1:215 OCEAN DRIVE LOOP APT B
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7966
Mailing Address - Country:US
Mailing Address - Phone:907-399-2500
Mailing Address - Fax:
Practice Address - Street 1:215 OCEAN DRIVE LOOP APT B
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7966
Practice Address - Country:US
Practice Address - Phone:907-399-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1002586251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1002586Medicaid