Provider Demographics
NPI:1467515148
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 1:301 KENAI STREET
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:AK
Practice Address - Zip Code:99693
Practice Address - Country:US
Practice Address - Phone:907-472-2303
Practice Address - Fax:907-472-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK021833Medicare Oscar/Certification