NPIMap

Organization Active NPI

Kic/THC Behavioral Health Department

  • Community/Behavioral Health Agency
  • Ketchikan, AK
National Provider Identifier
1073766317
Registry record updated Oct 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
KIC/THC BEHAVIORAL HEALTH DEPARTMENT
Practice address
2960 Tongass Ave FL 1
Ketchikan, AK 99901-5742
Phone
(907) 228-4917
Fax
(907) 228-4920
NPI assigned
Oct 30, 2008
Organization subpart
Yes
Parent organization
KETCHIKAN INDIAN COMMUNITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Debbie Patton, MPA
Title
General Manager
Phone
(907) 228-4926

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X AK Primary

Addresses

Primary practice location

2960 Tongass Ave FL 1
Ketchikan, AK 99901-5742

Mailing address

2960 Tongass Ave FL 1
Ketchikan, AK 99901-5742
Phone (907) 228-4917

Other identifiers 1

IdentifierTypeStateIssuer
DA2696MedicaidAK

Other names 1

  • KIC Social Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Kicthc Behavioral Health Department7 organizations share this tax ID, including this one
Part of
Kicthc Behavioral Health Department

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2960 Tongass Ave
Fl 1
Ketchikan, AK 99901
Phone (907) 228-4917

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225324800000",
    "number": "1073766317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE FL 1",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-4917",
            "fax_number": "907-228-4920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 TONGASS AVE FL 1",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015742",
            "telephone_number": "907-228-4917",
            "fax_number": "907-228-4920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIC/THC BEHAVIORAL HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETCHIKAN INDIAN COMMUNITY",
        "enumeration_date": "2008-10-30",
        "last_updated": "2008-10-30",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "907-228-4926",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA2696",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KIC Social Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ketchikan, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.