Provider Demographics
NPI:1205097862
Name:VALDEZ SENIOR CITIZEN CENTER
Entity type:Organization
Organization Name:VALDEZ SENIOR CITIZEN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:KESSE
Authorized Official - Suffix:
Authorized Official - Credentials:BHS
Authorized Official - Phone:907-835-5032
Mailing Address - Street 1:1300 E HANAGITA
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686
Mailing Address - Country:US
Mailing Address - Phone:907-835-5032
Mailing Address - Fax:
Practice Address - Street 1:1300 E HANAGITA
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686-1300
Practice Address - Country:US
Practice Address - Phone:907-835-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG6646Medicaid