Provider Demographics
NPI:1053955674
Name:TANANA CHIEFS CONFENERCE
Entity type:Organization
Organization Name:TANANA CHIEFS CONFENERCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX. DIRECTOR OF H.S.
Authorized Official - Prefix:
Authorized Official - First Name:JACOLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-8251
Mailing Address - Street 1:122 1ST AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4871
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:
Practice Address - Street 1:1300 MOORE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5761
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANANA CHIEFS CONFENERCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health