ALEXANDRA ACTIVE (NPI# 1164896775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164896775 |
| Entity Type | Individual |
| Full Name | ALEXANDRA ACTIVE |
| Practice Address |
460 Ridgecrest Drive Suite 215 Bethel AK 99559-0528 |
| Mailing Address |
Po Box 528 Attn: Bh Dd Services Bethel AK 99559-0528 |
| Practice Telephone | 9075432762 |
| Practice Fax Number | 9075433152 |
| Mailing Telephone | 9075432762 |
| Mailing Fax Number | 9075433152 |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2015-11-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1002447 | 05 |
| Street Address |
460 RIDGECREST DRIVE SUITE 215 |
| City | BETHEL |
| State | AK |
| Zip Code | 99559-0528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508052820 | Serena Rose Solesbee | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559-0528 | 2007-09-20 |
| 1710404074 | Kira Polk | Day Training/Habilitation Specialist | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2017-08-28 |
| 1225565831 | Deonna Graham | Day Training/Habilitation Specialist | 460 Ridgecrest Drive, Suite 214, Bethel, AK 99559-0528 | 2017-05-12 |
| 1619423571 | Rochelle Andrews | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 209, Bethel, AK 99559-0528 | 2016-08-31 |
| 1750737292 | Stacy Taylor | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 209, Bethel, AK 99559-0528 | 2016-05-13 |
| 1275909012 | Jaris Michaels | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2015-08-17 |
| 1013383850 | Ivy Katherine Riley | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2015-08-17 |
| 1962880237 | Colleen Chase | Case Manager/Care Coordinator | 460 Ridgecrest Drive, Suite 215, Bethel, AK 99559 | 2015-05-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194337519 | Michael P Nicolai | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hey, Bethel, AK 99559 | 2020-08-18 |
| 1003438508 | Enc Physical Therapy LLC | Physical Therapist | 223 Blackberry Street, Unit A, Bethel, AK 99559 | 2020-05-07 |
| 1780229609 | Laline Knox | Massage Therapist | 107 Alex Hatley Ste 1, Bethel, AK 99559 | 2019-11-14 |
| 1659920502 | Ana Celina Sebastian | Counselor | 1380 Calista Dr, Bethel, AK 99559 | 2019-09-04 |
| 1639730484 | Jerri Linda Moran-gentle | Massage Therapist | 430 A 7th Ave, Bethel, AK 99559 | 2019-06-24 |
| 1528625381 | Jennifer Peeks | Social Worker | 631 4th Ave. & Main St., Bethel, AK 99559 | 2019-05-28 |
| 1710451190 | Mary Theresa Thibeault | Registered Nurse | Bethel Public Health Center, 1490 Eddie Hoffman Highway, Bethel, AK 99559 | 2019-01-18 |
| 1659846210 | Freda Lizann Jimmie | Counselor | 829 Eddie Hoffman Highway, Bethel, AK 99559 | 2018-10-10 |
| 1073093977 | Romeo Mullai | Counselor | 1630 Calista Drive, Bethel, AK 99559 | 2018-08-20 |
| 1235623794 | Brian Justin Moses | Day Training/Habilitation Specialist | 841 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2018-06-19 |
| Find all providers in zip 99559 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194337519 | Michael P Nicolai | Case Manager/Care Coordinator | 829 Chief Eddie Hoffman Hey, Bethel, AK 99559 | 2020-08-18 |
| 1447606710 | Sophie Jenkins | Case Manager/Care Coordinator | 185 Hoffman Subdivision, Bethel, AK 99558-0528 | 2016-05-05 |
| 1245607217 | Willie John | Case Manager/Care Coordinator | 185 Hoffman Road, Bethel, AK 99559-0528 | 2015-08-26 |
| 1487068847 | Julia Agnes Street | Case Manager/Care Coordinator | 460 Ridgecrest Drive Suite 215, Bethel, AK 99559-0528 | 2014-06-13 |
| 1689084733 | Jaimie Lynn Kassman | Case Manager/Care Coordinator | 833 Cheif Eddie Hoffman Hwy, Bethel, AK 99559 | 2014-04-29 |
| 1063843233 | Gracie Nelson | Case Manager/Care Coordinator | 700 Cheif Eddie Hoffman Hwy, Bethel, AK 99559-7000 | 2013-12-12 |
| 1346686045 | Stephanie Pauline Moses | Case Manager/Care Coordinator | 829 Cheif Eddie Hoffman Highway, Bethel, AK 99559 | 2013-05-21 |
| 1386997286 | Kristin K Peterson | Case Manager/Care Coordinator | 831 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2012-10-17 |
| 1285909770 | Shannon Liat Irving | Case Manager/Care Coordinator | 460 Ridgecrest Ave, Family Infant Toddler Program-suite 214, Bethel, AK 99559-0281 | 2012-03-15 |
| 1538490198 | Barbara G. Liu | Case Manager/Care Coordinator | 460 Ridgecrest Dr., Suite 214, Bethel, AK 99559 | 2010-01-21 |
| Find all providers in BETHEL | ||||
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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.