Provider Demographics
NPI:1508269580
Name:ALASKA SOCIAL WORK & NURSING CONSORTIUM,LLC
Entity Type:Organization
Organization Name:ALASKA SOCIAL WORK & NURSING CONSORTIUM,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BC
Authorized Official - Phone:907-726-1115
Mailing Address - Street 1:19715 WAR ADMIRAL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8473
Mailing Address - Country:US
Mailing Address - Phone:907-726-1115
Mailing Address - Fax:
Practice Address - Street 1:19715 WAR ADMIRAL RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8473
Practice Address - Country:US
Practice Address - Phone:907-726-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK311041C0700X
AK35531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty