Provider Demographics
NPI:1356630917
Name:YUKON KOYUKUK ELDER ASSISTED LIVING CONSORTIUM
Entity Type:Organization
Organization Name:YUKON KOYUKUK ELDER ASSISTED LIVING CONSORTIUM
Other - Org Name:YUKON KOYUKUK ELDER ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-656-2574
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:AK
Mailing Address - Zip Code:99741-0189
Mailing Address - Country:US
Mailing Address - Phone:907-656-2574
Mailing Address - Fax:
Practice Address - Street 1:2 1/4 CAMPION ROAD
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:AK
Practice Address - Zip Code:99741
Practice Address - Country:US
Practice Address - Phone:907-656-2574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility