Provider Demographics
NPI:1174948665
Name:KODIAK AREA NATIVE ASSOCIATION
Entity type:Organization
Organization Name:KODIAK AREA NATIVE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF ADMINISTRA
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-486-9816
Mailing Address - Street 1:3449 REZANOF DR E
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6952
Mailing Address - Country:US
Mailing Address - Phone:907-486-9800
Mailing Address - Fax:907-486-1345
Practice Address - Street 1:3449 REZANOF DR E
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6952
Practice Address - Country:US
Practice Address - Phone:907-486-9800
Practice Address - Fax:907-486-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management