Provider Demographics
NPI:1659825776
Name:PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Entity Type:Organization
Organization Name:PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Other - Org Name:KENAI
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-260-7314
Mailing Address - Street 1:PO BOX 2949
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2949
Mailing Address - Country:US
Mailing Address - Phone:907-260-7300
Mailing Address - Fax:907-260-7301
Practice Address - Street 1:805 FRONTAGE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9104
Practice Address - Country:US
Practice Address - Phone:907-283-3600
Practice Address - Fax:907-283-3601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-05
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK920499261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)