Provider Demographics
NPI:1871725242
Name:METLAKATLA INDIAN COMMUNITY
Entity type:Organization
Organization Name:METLAKATLA INDIAN COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SERVICE UNIT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ASKREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-886-6601
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:METLAKATLA
Mailing Address - State:AK
Mailing Address - Zip Code:99926-0439
Mailing Address - Country:US
Mailing Address - Phone:907-886-4741
Mailing Address - Fax:907-886-6976
Practice Address - Street 1:563 BRENDIBLE STREET
Practice Address - Street 2:
Practice Address - City:METLAKATLA
Practice Address - State:AK
Practice Address - Zip Code:99926-0439
Practice Address - Country:US
Practice Address - Phone:907-886-4741
Practice Address - Fax:907-886-6976
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METLAKATLA INDIAN COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG037Medicaid