Provider Demographics
NPI:1851915953
Name:SUNDANCE AK CARE COORDINATION LLC
Entity Type:Organization
Organization Name:SUNDANCE AK CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-227-1073
Mailing Address - Street 1:11830 NORTHERN RAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1978
Mailing Address - Country:US
Mailing Address - Phone:907-227-1073
Mailing Address - Fax:866-860-8154
Practice Address - Street 1:11830 NORTHERN RAVEN DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1978
Practice Address - Country:US
Practice Address - Phone:907-227-1073
Practice Address - Fax:866-860-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management