NPIMap

Organization Active NPI

Maniilaq Association Ksccc

  • Assisted Living Facility
  • Kotzebue, AK
National Provider Identifier
1629109939
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
000063 Issued in AK
Legal business name
MANIILAQ ASSOCIATION KSCCC
Practice address
607 Wolverine Drive
Kotzebue, AK 99752-1073
Phone
(907) 442-7917
Fax
(907) 442-7932
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Kellie B. Haas, LPN
Title
Elder Services Director
Phone
(907) 442-7917

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 000063 AK Primary

Addresses

Primary practice location

607 Wolverine Drive
Kotzebue, AK 99752-1073

Mailing address

PO Box 1073
Kotzebue, AK 99752-1073
Phone (907) 442-7917

Other identifiers 2

IdentifierTypeStateIssuer
RL3590MedicaidAK
CMG590MedicaidAK

Other names 1

  • Kotzebue Senior Citizens Cultural Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Buckland Clinic45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629109939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1073",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997521073",
            "telephone_number": "907-442-7917",
            "fax_number": "907-442-7932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 WOLVERINE DRIVE",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997521073",
            "telephone_number": "907-442-7917",
            "fax_number": "907-442-7932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANIILAQ ASSOCIATION KSCCC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "ELDER SERVICES DIRECTOR",
        "authorized_official_telephone_number": "907-442-7917",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "000063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL3590",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMG590",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kotzebue Senior Citizens Cultural Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kotzebue, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.