Provider Demographics
NPI:1033725684
Name:KNIK TRIBE
Entity Type:Organization
Organization Name:KNIK TRIBE
Other - Org Name:BENTEH WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-671-6871
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DRIVE
Mailing Address - Street 2:STE B PMB 797
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-671-6871
Mailing Address - Fax:
Practice Address - Street 1:780 S SNODGRASS DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9149
Practice Address - Country:US
Practice Address - Phone:907-373-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNIK TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-18
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty