Provider Demographics
NPI:1457574212
Name:ALASKA HEMOPHILIA ASSOCIATION & TREATMENT PROGRAM
Entity Type:Organization
Organization Name:ALASKA HEMOPHILIA ASSOCIATION & TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MED
Authorized Official - Phone:907-243-4045
Mailing Address - Street 1:2808 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3251
Mailing Address - Country:US
Mailing Address - Phone:907-243-4045
Mailing Address - Fax:907-243-4043
Practice Address - Street 1:2808 ASPEN DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3251
Practice Address - Country:US
Practice Address - Phone:907-243-4045
Practice Address - Fax:907-243-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty