Provider Demographics
NPI:1780833301
Name:STATE OF ALASKA, DEPARTMENT OF ADMINISTRATION
Entity Type:Organization
Organization Name:STATE OF ALASKA, DEPARTMENT OF ADMINISTRATION
Other - Org Name:WCFH SPECIALTY CLINICS
Other - Org Type:Other Name
Authorized Official - Title/Position:SECTION CHIEF, WOMEN'S, CHILDREN'S
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORISSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:907-334-2424
Mailing Address - Street 1:3601 C STREET, WCFH, SPECIALTY CLINICS
Mailing Address - Street 2:SUITE 322
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-269-3400
Mailing Address - Fax:907-754-3425
Practice Address - Street 1:3601 C STREET, WCFH, SPECIALTY CLINICS
Practice Address - Street 2:SUITE 322
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-269-3400
Practice Address - Fax:907-754-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty