Provider Demographics
NPI:1821290925
Name:EASTERN ALEUTIAN TRIBES, INC.
Entity Type:Organization
Organization Name:EASTERN ALEUTIAN TRIBES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-277-1440
Mailing Address - Street 1:3380 C ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3920
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1446
Practice Address - Street 1:527 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SAND POINT
Practice Address - State:AK
Practice Address - Zip Code:99661
Practice Address - Country:US
Practice Address - Phone:907-383-3151
Practice Address - Fax:907-383-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH4238Medicaid