Provider Demographics
NPI:1942757711
Name:KENKAMKEN CARE COORDINATION
Entity Type:Organization
Organization Name:KENKAMKEN CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CARE COORDINATION
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRONGHEART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-740-1272
Mailing Address - Street 1:129 SPRUCEWOOD DR APT 1
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6838
Mailing Address - Country:US
Mailing Address - Phone:907-740-1272
Mailing Address - Fax:
Practice Address - Street 1:129 SPRUCEWOOD DR APT 1
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6838
Practice Address - Country:US
Practice Address - Phone:907-740-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104199251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management