KIC/THC BEHAVIORAL HEALTH DEPARTMENT (NPI# 1073766317) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073766317 |
| Entity Type | Organization |
| Organization Name | KIC/THC BEHAVIORAL HEALTH DEPARTMENT |
| Other Organization Name | KIC SOCIAL SERVICES |
| Practice Address |
2960 Tongass Ave Fl 1 Ketchikan AK 99901-5742 |
| Practice Telephone | 9072284917 |
| Practice Fax Number | 9072284920 |
| Mailing Telephone | 9072284917 |
| Mailing Fax Number | 9072284920 |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2008-10-30 |
| Authorized Official Name | MS. DEBBIE PATTON (GENERAL MANAGER) |
| Authorized Official Telephone | 9072284926 |
| Authorized Official Credential | MPA |
| Is Organization Subpart | Y |
| Parent Organization Name | KETCHIKAN INDIAN COMMUNITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | AK | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DA2696 | 05 |
| Other Name | Type Code |
|---|---|
| KIC Social Services | Other Name - Individual/Organization |
| Street Address |
2960 TONGASS AVE FL 1 |
| City | KETCHIKAN |
| State | AK |
| Zip Code | 99901-5742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314215 | Residential Youth Care, Inc. | Community/Behavioral Health | 2442 Tongass Avenue, Ketchikan, AK 99901 | 2020-07-23 |
| 1316563026 | Residential Youth Care, Inc. | Community/Behavioral Health | 606 Hill Road, Ketchikan, AK 99901 | 2020-06-18 |
| 1043836851 | Residential Youth Care, Inc. | Community/Behavioral Health | 2514 1st Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1215553029 | Residential Youth Care, Inc. | Community/Behavioral Health | 2951 Baranof Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1174159222 | Helene Rae Simpson | Behavior Technician | 201 Deermont St, Ketchikan, AK 99901 | 2020-03-20 |
| 1003295155 | Suzanne Webb | Massage Therapist | 602 Dock St Ste 106, Ketchikan, AK 99901 | 2015-05-22 |
| 1093194342 | Kate Mortensen | Case Manager/Care Coordinator | 2690 Tongass Ave, Ketchikan, AK 99901 | 2015-05-20 |
| 1578879631 | Thomas Peter Ryan | Social Worker | 320 Bawden St. #318, Ketchikan, AK 99901 | 2010-08-27 |
| 1689820979 | Akeela Inc | Community Based Residential Treatment Facility, Mental Illness | 3050 Fifth Ave, Ketchikan, AK 99901 | 2008-08-18 |
| 1750565438 | Susan Marie Swift | Nurse Practitioner | 21 Jefferson Way, Suite 202, Psychiatry, Ketchikan, AK 99901 | 2007-12-18 |
| Find all providers in zip 99901 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314215 | Residential Youth Care, Inc. | Community/Behavioral Health | 2442 Tongass Avenue, Ketchikan, AK 99901 | 2020-07-23 |
| 1316563026 | Residential Youth Care, Inc. | Community/Behavioral Health | 606 Hill Road, Ketchikan, AK 99901 | 2020-06-18 |
| 1043836851 | Residential Youth Care, Inc. | Community/Behavioral Health | 2514 1st Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1215553029 | Residential Youth Care, Inc. | Community/Behavioral Health | 2951 Baranof Avenue, Ketchikan, AK 99901 | 2020-06-18 |
| 1568061232 | Community Connections | Community/Behavioral Health | 721 Stedman St, Ketchikan, AK 99901-6632 | 2020-10-22 |
| 1336771781 | Residential Youth Care, Inc. | Community/Behavioral Health | 2524 1st Avenue, Ketchikan, AK 99901 | 2020-02-04 |
| 1669010922 | Akeela Inc | Community/Behavioral Health | 3050 Fifth Ave, Ketchikan, AK 99901-5773 | 2019-12-18 |
| 1346601457 | State of Alaska Public Health Nursing | Community/Behavioral Health | 3054 Fifth Ave, Ketchikan, AK 99901-5773 | 2016-03-16 |
| 1588834154 | Ketchikan Indian Community | Community/Behavioral Health | 2960 Tongass Ave, Ketchikan, AK 99901-5742 | 2008-03-10 |
| 1346423415 | Community Connections | Community/Behavioral Health | 201 Deermount St, Ketchikan, AK 99901-6649 | 2007-12-12 |
| Find all providers in KETCHIKAN | ||||
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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.