Basic Information
| Provider Information | |||||||||
| NPI: | 1124741665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YAKUTAT COMMUNITY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 112 | ||||||||
| Address2: | |||||||||
| City: | YAKUTAT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996890112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077843275 | ||||||||
| FaxNumber: | 9077843263 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 AIRPORT ROAD | ||||||||
| Address2: | |||||||||
| City: | YAKUTAT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077843275 | ||||||||
| FaxNumber: | 9077843286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | RHODA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9077843275 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.