Provider Demographics
NPI:1235595562
Name:CHITINA TRADITIONAL INDIAN VILLAGE COUNCIL
Entity Type:Organization
Organization Name:CHITINA TRADITIONAL INDIAN VILLAGE COUNCIL
Other - Org Name:CHITINA TRIBAL AND COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TYONE
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:907-823-2215
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:CHITINA
Mailing Address - State:AK
Mailing Address - Zip Code:99566-0031
Mailing Address - Country:US
Mailing Address - Phone:907-823-2213
Mailing Address - Fax:
Practice Address - Street 1:MILE 28.5 EDGERTON HWY
Practice Address - Street 2:
Practice Address - City:CHITINA
Practice Address - State:AK
Practice Address - Zip Code:99566
Practice Address - Country:US
Practice Address - Phone:907-823-2213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK306263261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health