Organization
TANANA CHIEFS CONFERENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY ISSAC (CEO)
(907) 452-8251
Entity
Organization
Contact information
Practice address
122 1ST AVE STE 600, FAIRBANKS, AK 99701-4871
(907) 452-8251
Mailing address
122 1ST AVE STE 600, FAIRBANKS, AK 99701-4871
(907) 452-8251
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
AK
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
AK
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMG 438
—
AK
Enumeration date
10/02/2012
Last updated
10/02/2012
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