Provider Demographics
NPI:1922121789
Name:CHUGIAK SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:CHUGIAK SENIOR CITIZENS, INC.
Other - Org Name:
Other - Org Type:
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 N BIRCHWOOD LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0000
Mailing Address - Country:US
Mailing Address - Phone:907-688-2678
Mailing Address - Fax:907-688-1319
Practice Address - Street 1:22424 N BIRCHWOOD LOOP ROAD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99567-0000
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:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121981251C00000X
121981261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC5987Medicare ID - Type UnspecifiedADULT DAY SERVICE