Provider Demographics
NPI:1124180963
Name:EASTERN ALEUTIAN TRIBES, INC.
Entity Type:Organization
Organization Name:EASTERN ALEUTIAN TRIBES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DAHLE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-277-1440
Mailing Address - Street 1:3380 C STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1436
Practice Address - Street 1:65 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:COLD BAY
Practice Address - State:AK
Practice Address - Zip Code:99571
Practice Address - Country:US
Practice Address - Phone:907-532-2000
Practice Address - Fax:907-532-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X, 261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL6515Medicaid
AKK0000WCPFTMedicare Oscar/Certification