Provider Demographics
NPI:1093840324
Name:NINILCHIK SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:NINILCHIK SENIOR CITIZENS, INC.
Other - Org Name:NINILCHIK SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:THB
Authorized Official - Phone:907-567-3988
Mailing Address - Street 1:PO BOX 39422
Mailing Address - Street 2:
Mailing Address - City:NINILCHIK
Mailing Address - State:AK
Mailing Address - Zip Code:99639-0422
Mailing Address - Country:US
Mailing Address - Phone:907-567-3988
Mailing Address - Fax:907-567-3968
Practice Address - Street 1:66265 ASPEN AVE
Practice Address - Street 2:
Practice Address - City:NINILCHIK
Practice Address - State:AK
Practice Address - Zip Code:99639-0422
Practice Address - Country:US
Practice Address - Phone:907-567-3988
Practice Address - Fax:907-567-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK724049251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC3828Medicaid