Provider Demographics
NPI:1376520692
Name:ILIULIUK FAMILY AND HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ILIULIUK FAMILY AND HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KAECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-581-8658
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:UNALASKA
Mailing Address - State:AK
Mailing Address - Zip Code:99685-0144
Mailing Address - Country:US
Mailing Address - Phone:907-581-1202
Mailing Address - Fax:907-581-2331
Practice Address - Street 1:34 LAVELLE COURT
Practice Address - Street 2:
Practice Address - City:UNALASKA
Practice Address - State:AK
Practice Address - Zip Code:99685-0144
Practice Address - Country:US
Practice Address - Phone:907-581-2331
Practice Address - Fax:907-581-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147861101YM0800X, 122300000X, 363A00000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRH522FQMedicaid
AKRH522FQMedicaid