Provider Demographics
NPI:1659817054
Name:SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type:Organization
Organization Name:SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Other - Org Name:SEARHC AICS NAUKATI CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-4000
Mailing Address - Street 1:3100 CHANNEL DR STE 300
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-463-4000
Mailing Address - Fax:907-463-1510
Practice Address - Street 1:NAUKATI COMMUNITY CHURCH
Practice Address - Street 2:
Practice Address - City:NAUKATI
Practice Address - State:AK
Practice Address - Zip Code:99950
Practice Address - Country:US
Practice Address - Phone:907-874-4700
Practice Address - Fax:907-874-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK70206OtherBUSINESS LICENSE