Provider Demographics
NPI:1649642786
Name:NATIVE VLLAGE OF EKLUTNA
Entity type:Organization
Organization Name:NATIVE VLLAGE OF EKLUTNA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:90768-860-1808
Mailing Address - Street 1:26339 EKLUTNA VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5148
Mailing Address - Country:US
Mailing Address - Phone:907-688-6031
Mailing Address - Fax:907-688-6032
Practice Address - Street 1:26339 EKLUTNA VILLAGE RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5148
Practice Address - Country:US
Practice Address - Phone:907-688-6031
Practice Address - Fax:907-688-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1025602261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)