Provider Demographics
NPI:1790011195
Name:SUSAN REED
Entity Type:Organization
Organization Name:SUSAN REED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-7395
Mailing Address - Street 1:4020 N GREY WOLF DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-1837
Mailing Address - Country:US
Mailing Address - Phone:907-357-7395
Mailing Address - Fax:907-357-9599
Practice Address - Street 1:4020 N GREY WOLF DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-1837
Practice Address - Country:US
Practice Address - Phone:907-357-7395
Practice Address - Fax:907-357-9599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE CORE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK435062251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1013126929Medicaid