PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA (NPI# 1124110796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124110796 |
| Entity Type | Organization |
| Organization Name | PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA |
| Other Organization Name | COTTONWOOD BEHAVIOR HEALTH |
| Practice Address |
230 E Marydale Ave Suite 2 Soldotna AK 99669-7648 |
| Practice Telephone | 9072603691 |
| Practice Fax Number | 9072603697 |
| Mailing Telephone | 9072603691 |
| Mailing Fax Number | 9072603697 |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2008-09-30 |
| Authorized Official Name | MRS. CONNIE S. WINTERS (OFFICE MANAGER & A/R SUPERVISOR) |
| Authorized Official Telephone | 9072603691 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QA0600X |
Clinic/Center Specialization: Adult Day Care |
64033 | AK | Ambulatory Health Care Facilities |
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
AK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MH0156 | 05 |
| Other Name | Type Code |
|---|---|
| Cottonwood Behavior Health | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PENINSULA COMMUNITY HEALTH SERVICES OF ALASKA, INC. | 230 E Marydale Ave Ste 3, Soldotna, AK 99669-7648 |
| Street Address |
230 E MARYDALE AVE SUITE 2 |
| City | SOLDOTNA |
| State | AK |
| Zip Code | 99669-7648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780676502 | Susan J Holit | Nurse Practitioner | 230 E Marydale Ave, Suite 1, Soldotna, AK 99669-7636 | 2005-08-17 |
| 1700403235 | Abigail Jorgensen | Family Medicine | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2020-06-30 |
| 1770113193 | Kawal Jooma | Social Worker | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2020-01-24 |
| 1649810433 | Chad Andrews | Nurse Practitioner | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2020-01-09 |
| 1922651587 | Jenni Rachel Brighton | Counselor | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2019-07-22 |
| 1639722895 | Jana Lynn Focose | Case Manager/Care Coordinator | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2019-07-17 |
| 1851943690 | Sherrie Barlow | Counselor | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2019-07-11 |
| 1942852702 | Daniel Shane Hill | Counselor | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2019-07-11 |
| 1144882606 | Jennifer Morris | Community Health Worker | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2019-07-05 |
| 1255993200 | Ashley Christine Wiedermann | Counselor | 230 E Marydale Ave, Soldotna, AK 99669-7648 | 2019-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881201226 | Kyle Arron Shassetz | Counselor | 43335 K-beach Rd., Soldotna, AK 99669 | 2020-09-29 |
| 1720614993 | Peninsula Instacare | Clinic/Center | 34581 Kenai Spur Hwy, Suite 1, Soldotna, AK 99669 | 2020-03-19 |
| 1871141077 | Alaine Viola Lagasse | Counselor | Kenai Vet Center, 43299 Kalifornsky Beach Road Ste 4, Soldotna, AK 99669 | 2019-08-30 |
| 1962970574 | Ryder R Storm | Behavior Technician | 338800 Community College Drive, Suite 1, Soldotna, AK 99669 | 2018-11-13 |
| 1356821540 | Tanecia Webster | Nurse Practitioner | 36570 Kenai Spur Hwy, Ste 103a, Soldotna, AK 99669 | 2018-08-16 |
| 1821519869 | Theresa Napolitano | Case Manager/Care Coordinator | 35477 Kenai Spur Hwy Suite 203, Soldotna, AK 99669 | 2017-06-29 |
| 1689048282 | Jeanne Bignell | Licensed Practical Nurse | 35020 Alaskan View Lane, Soldotna, AK 99669 | 2015-11-19 |
| 1952786105 | Ian Charles Mcmullen | Pharmacist | 44001 Sterling Highway, Soldotna, AK 99669 | 2015-07-29 |
| 1841679933 | Lana Clymer | Case Manager/Care Coordinator | 22994 Kalifornsky Beach Rd, Soldotna, AK 99669 | 2015-05-22 |
| 1861800773 | Phillip Bruce | Physical Therapy Assistant | 35105 Kenai Spury Hwy, Suite A, Soldotna, AK 99669 | 2014-07-24 |
| Find all providers in zip 99669 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639652662 | Southcentral Foundation | Clinic/Center | 26341 Eklutna Village Rd, Chugiak, AK 99567-5148 | 2018-09-14 |
| 1881047108 | Aleutian Pribilof Islands Association | Clinic/Center | 111 Lakeview Rd., Nikolski, AK 99638 | 2016-07-21 |
| 1609232040 | Southcentral Foundation | Clinic/Center | 101 Indian Creek Road, Tyonek, AK 99682 | 2016-01-14 |
| 1235595562 | Chitina Traditional Indian Village Council | Clinic/Center | Mile 28.5 Edgerton Hwy, Chitina, AK 99566 | 2015-12-31 |
| 1770953903 | Southcentral Foundation | Clinic/Center | 1 Flight Line Rd, Port Alsworth, AK 99653-9801 | 2015-09-30 |
| 1144699216 | Southcentral Foundation | Clinic/Center | 4030 Salmon Way, Iguigig, AK 99613 | 2015-09-18 |
| 1295104644 | Southcentral Foundation | Clinic/Center | 102 Fireweed Lane, Newhalen, AK 99606 | 2015-09-16 |
| 1952770307 | Southcentral Foundation | Clinic/Center | 2516 Mountain Circle, Pedro Bay, AK 99647 | 2015-09-16 |
| 1205255957 | Front Street Health Center | Clinic/Center | 225 Front St Ste 202, Juneau, AK 99801-1244 | 2014-04-09 |
| 1043632037 | Southcentral Foundation | Clinic/Center | 11495 N Callison Street, Sutton, AK 99674 | 2014-01-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.