Provider Demographics
NPI:1134241573
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 BIRCHWOOD LOOP RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-6476
Mailing Address - Country:US
Mailing Address - Phone:907-688-2678
Mailing Address - Fax:907-688-1319
Practice Address - Street 1:22424 BIRCHWOOD LOOP RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-6476
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:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000012385H00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered385H00000XRespite Care FacilityRespite Care
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL9259Medicare ID - Type UnspecifiedASSISTED LIVING SERVICE