Provider Demographics
NPI:1013205608
Name:TANANA CHIEFS CONFERENCE
Entity Type:Organization
Organization Name:TANANA CHIEFS CONFERENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAMP COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EFFIE
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-8251
Mailing Address - Street 1:2223 GILLAM WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6818
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3810
Practice Address - Street 1:201 1ST AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4848
Practice Address - Country:US
Practice Address - Phone:907-451-8251
Practice Address - Fax:907-459-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3245S0500X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility