Provider Demographics
NPI:1609680842
Name:KNIK TRIBE
Entity type:Organization
Organization Name:KNIK TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELDER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-373-7991
Mailing Address - Street 1:PO BOX 871565
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-1565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1744 N PROSPECT DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9655
Practice Address - Country:US
Practice Address - Phone:907-373-7991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care