Provider Demographics
NPI:1659829117
Name:ALASKA INDEPENDENT CARE COORDINATION
Entity Type:Organization
Organization Name:ALASKA INDEPENDENT CARE COORDINATION
Other - Org Name:AK ICC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HOWDYSHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-748-0886
Mailing Address - Street 1:12001 WOODWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-2048
Mailing Address - Country:US
Mailing Address - Phone:907-748-0886
Mailing Address - Fax:907-748-0886
Practice Address - Street 1:12001 WOODWAY CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-2048
Practice Address - Country:US
Practice Address - Phone:907-748-0886
Practice Address - Fax:907-748-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1042063251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1598085292Medicaid