1902077837 NPI number — CHUGACHMIUT

Table of content: (NPI 1902077837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902077837 NPI number — CHUGACHMIUT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHUGACHMIUT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902077837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1840 BRAGAW ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-3463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-562-4155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63998 GRAHAM ROAD UNIT #3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT GRAHAM
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-284-2241
Provider Business Practice Location Address Fax Number:
907-284-2277
Provider Enumeration Date:
03/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH SERVICES DIVISION DIRECTOR
Authorized Official Telephone Number:
907-334-0148

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1581154 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com