Provider Demographics
NPI:1801372362
Name:INTERIOR CARE COORDINATION LLC
Entity Type:Organization
Organization Name:INTERIOR CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-978-5023
Mailing Address - Street 1:PO BOX 55130
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-0130
Mailing Address - Country:US
Mailing Address - Phone:907-978-5023
Mailing Address - Fax:
Practice Address - Street 1:5170 SUNDOWN TRL
Practice Address - Street 2:
Practice Address - City:SALCHA
Practice Address - State:AK
Practice Address - Zip Code:99714-9756
Practice Address - Country:US
Practice Address - Phone:907-978-5023
Practice Address - Fax:877-237-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty