Basic Information
| Provider Information | |||||||||
| NPI: | 1952748386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTER | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | GEORGIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 150 | ||||||||
| Address2: | ATTN: BEHAVIORAL HEALTH | ||||||||
| City: | SCAMMON BAY | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996620150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075585856 | ||||||||
| FaxNumber: | 9075585705 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | SCAMMON BAY | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996620129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075585856 | ||||||||
| FaxNumber: | 9075585705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2013 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | BHA II | AK | Y | Other Service Providers | Community Health Worker |
ID Information
| ID | Type | State | Issuer | Description | 1020986 | 05 | AK | MEDICAID |