Provider Demographics
NPI:1366517112
Name:NORTH SLOPE BOROUGH
Entity type:Organization
Organization Name:NORTH SLOPE BOROUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-852-2611
Mailing Address - Street 1:1274 AGVIK STREET
Mailing Address - Street 2:
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723
Mailing Address - Country:US
Mailing Address - Phone:907-852-0362
Mailing Address - Fax:907-852-7965
Practice Address - Street 1:1274 AGVIQ STREET
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-852-0362
Practice Address - Fax:907-852-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK800203AK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH2378Medicaid
AKDA2378Medicaid