Provider Demographics
NPI:1205164332
Name:MANIILAQ ASSOCIATION
Entity type:Organization
Organization Name:MANIILAQ ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR TRAINEE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATORUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-475-2291
Mailing Address - Street 1:P.O. BOX 256
Mailing Address - Street 2:435 SECOND STREET TED STEVENS WAY
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0256
Mailing Address - Country:US
Mailing Address - Phone:907-442-7640
Mailing Address - Fax:
Practice Address - Street 1:435 SECOND STREET TED STEVENS WAY
Practice Address - Street 2:
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-0256
Practice Address - Country:US
Practice Address - Phone:907-442-7640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility