Provider Demographics
NPI:1710008586
Name:COMMUNITY OF CANTWELL, INC.
Entity Type:Organization
Organization Name:COMMUNITY OF CANTWELL, INC.
Other - Org Name:CANTWELL VOLUNTEER AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:AMBULANCE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:NORMA
Authorized Official - Last Name:NORD
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:907-768-2162
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:CANTWELL
Mailing Address - State:AK
Mailing Address - Zip Code:99729-0135
Mailing Address - Country:US
Mailing Address - Phone:907-768-2162
Mailing Address - Fax:907-768-2990
Practice Address - Street 1:MILE 133.8 DENALI HIGHWAY
Practice Address - Street 2:
Practice Address - City:CANTWELL
Practice Address - State:AK
Practice Address - Zip Code:99729-0135
Practice Address - Country:US
Practice Address - Phone:907-768-2162
Practice Address - Fax:907-768-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK50553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152640Medicare UPIN