Provider Demographics
NPI:1689914996
Name:INDIVIDUALS FIRST CARE COORDINATION
Entity Type:Organization
Organization Name:INDIVIDUALS FIRST CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-982-9343
Mailing Address - Street 1:PO BOX 3545
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-3545
Mailing Address - Country:US
Mailing Address - Phone:907-982-9343
Mailing Address - Fax:
Practice Address - Street 1:2041 N BROADWAY DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9314
Practice Address - Country:US
Practice Address - Phone:907-982-9343
Practice Address - Fax:907-746-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK980370251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMXOtherSDS PROVIDER NUMBER
AKCOS 68Medicaid