Provider Demographics
NPI:1558569251
Name:CHRYSTAL VAN SKY
Entity Type:Organization
Organization Name:CHRYSTAL VAN SKY
Other - Org Name:MIOWAK CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SKY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:907-776-5273
Mailing Address - Street 1:53908 TIAGA WAY
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-776-5273
Mailing Address - Fax:907-776-7081
Practice Address - Street 1:53908 TIAGA WAY
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611
Practice Address - Country:US
Practice Address - Phone:907-773-5273
Practice Address - Fax:907-776-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG456Medicaid