Provider Demographics
NPI:1689021412
Name:AK HIPPIE CHIC SERVICES
Entity Type:Organization
Organization Name:AK HIPPIE CHIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEE ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-690-4469
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:KASILOF
Mailing Address - State:AK
Mailing Address - Zip Code:99610-0392
Mailing Address - Country:US
Mailing Address - Phone:907-690-4469
Mailing Address - Fax:907-782-4145
Practice Address - Street 1:MILE 2 KALIFORNSKY BEACH ROAD
Practice Address - Street 2:
Practice Address - City:KASILOF
Practice Address - State:AK
Practice Address - Zip Code:99610-0392
Practice Address - Country:US
Practice Address - Phone:907-690-4469
Practice Address - Fax:907-782-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1574944251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management