Provider Demographics
NPI:1821074535
Name:NATIVE VILLAGE OF EYAK
Entity Type:Organization
Organization Name:NATIVE VILLAGE OF EYAK
Other - Org Name:ILANKA COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:907-424-3622
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-2290
Mailing Address - Country:US
Mailing Address - Phone:907-424-3622
Mailing Address - Fax:907-424-3275
Practice Address - Street 1:705 2ND STREET
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574
Practice Address - Country:US
Practice Address - Phone:907-424-3622
Practice Address - Fax:907-424-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK703435261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL7624Medicaid
AKCL7624Medicaid