Provider Demographics
NPI:1902245160
Name:RURAL CAP ALASKA
Entity Type:Organization
Organization Name:RURAL CAP ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ-VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RSS
Authorized Official - Phone:907-222-5259
Mailing Address - Street 1:120 N HOYT ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1602
Mailing Address - Country:US
Mailing Address - Phone:907-222-5259
Mailing Address - Fax:
Practice Address - Street 1:120 N HOYT ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1602
Practice Address - Country:US
Practice Address - Phone:907-222-5259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5890375920302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK9567840Medicaid