Provider Demographics
NPI:1437273000
Name:COOK INLET TRIBAL COUNCIL, INC
Entity Type:Organization
Organization Name:COOK INLET TRIBAL COUNCIL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-793-3600
Mailing Address - Street 1:3600 SAN JERONIMO DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2869
Mailing Address - Country:US
Mailing Address - Phone:907-793-3600
Mailing Address - Fax:907-793-3250
Practice Address - Street 1:3600 SAN JERONIMO DRIVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2869
Practice Address - Country:US
Practice Address - Phone:907-793-3600
Practice Address - Fax:907-793-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
AK88201261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1698489Medicaid
AK1698487Medicaid
AK1698479Medicaid
AK1698483Medicaid