Provider Demographics
NPI:1861014920
Name:NATIVE VILLAGE OF SCAMMON BAY
Entity Type:Organization
Organization Name:NATIVE VILLAGE OF SCAMMON BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NVSB THSEM TPHSS
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-764-2641
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SCAMMON BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99662-0126
Mailing Address - Country:US
Mailing Address - Phone:907-764-2641
Mailing Address - Fax:
Practice Address - Street 1:103 ASKINUK STREET
Practice Address - Street 2:
Practice Address - City:SCAMMON BAY
Practice Address - State:AK
Practice Address - Zip Code:99662
Practice Address - Country:US
Practice Address - Phone:907-764-2641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251V00000XAgenciesVoluntary or Charitable
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No385H00000XRespite Care FacilityRespite Care