| Organization Name: | CHICKALOON NATIVE VILLLAGE |
| NPI Number: | 1619267937 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMANDA NICOLE CHRISTIANSEN (CLINIC MANAGER) |
| Mailing Address: | 16166 North Glen Highway Mile 61.5 Glen Highway Sutton |
| State: | AK US |
| Postal Code: | 996741105 |
| Phone Number: | 9077450704 |
| Fax Number: | 9077450708 |
| NPI Enumeration Date: | 04/08/2011 |
| NPI Last Update Date: | 04/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |