Provider Demographics
NPI:1104951615
Name:RAILBELT MENTAL HEALTH ASSOCIATION
Entity type:Organization
Organization Name:RAILBELT MENTAL HEALTH ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-832-5557
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:207 E. 2ND ST.
Mailing Address - City:NENANA
Mailing Address - State:AK
Mailing Address - Zip Code:99760-0159
Mailing Address - Country:US
Mailing Address - Phone:907-832-5557
Mailing Address - Fax:
Practice Address - Street 1:207 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:NENANA
Practice Address - State:AK
Practice Address - Zip Code:99760
Practice Address - Country:US
Practice Address - Phone:907-832-5557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK726807261QR0405X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH2232Medicaid
AKDA1137Medicaid
AKK0000WCNBJMedicare ID - Type UnspecifiedPROVIDER NUMBER