Provider Demographics
NPI:1558708164
Name:CHUGIAK SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:CHUGIAK SENIOR CITIZENS, INC.
Other - Org Name:CHUGIAK -EAGLE RIVER HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-688-2678
Mailing Address - Street 1:22424 BIRCHWOOD LOOP RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-6476
Mailing Address - Country:US
Mailing Address - Phone:907-688-2678
Mailing Address - Fax:907-688-1319
Practice Address - Street 1:22424 BIRCHWOOD LOOP RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-6476
Practice Address - Country:US
Practice Address - Phone:907-688-2678
Practice Address - Fax:907-688-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK981720253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care