Provider Demographics
NPI:1457610230
Name:BOCK, HELENA MARY LOIS (COMMUNITY HEALTH AID)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:MARY LOIS
Last Name:BOCK
Suffix:
Gender:F
Credentials:COMMUNITY HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15765 KINGSLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:NINILCHIK
Mailing Address - State:AK
Mailing Address - Zip Code:99639-9368
Mailing Address - Country:US
Mailing Address - Phone:907-567-3970
Mailing Address - Fax:907-567-3902
Practice Address - Street 1:15765 KINGSLEY ROAD
Practice Address - Street 2:
Practice Address - City:NINILCHIK
Practice Address - State:AK
Practice Address - Zip Code:99639-9368
Practice Address - Country:US
Practice Address - Phone:907-567-3970
Practice Address - Fax:907-567-3902
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK99-206-IV261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health