Provider Demographics
NPI:1932114600
Name:KENAITZE INDIAN TRIBE
Entity Type:Organization
Organization Name:KENAITZE INDIAN TRIBE
Other - Org Name:DENA'INA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-335-7557
Mailing Address - Street 1:P.O. BOX 988
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611
Mailing Address - Country:US
Mailing Address - Phone:907-335-7550
Mailing Address - Fax:888-491-3360
Practice Address - Street 1:508 UPLAND STREET
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611
Practice Address - Country:US
Practice Address - Phone:907-335-7550
Practice Address - Fax:888-491-3360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENAITZE INDIAN TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD2004261Q00000X
261Q00000X, 261QF0400X, 261QH0100X, 332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL9243Medicaid
AKCL9243Medicaid
K0000WCHQMMedicare PIN
K0000WCHQMMedicare PIN