Healthcare Provider Details

I. General information

NPI: 1124741665
Provider Name (Legal Business Name): YAKUTAT COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 AIRPORT ROAD
YAKUTAT AK
99689
US

IV. Provider business mailing address

PO BOX 112
YAKUTAT AK
99689-0112
US

V. Phone/Fax

Practice location:
  • Phone: 907-784-3275
  • Fax: 907-784-3286
Mailing address:
  • Phone: 907-784-3275
  • Fax: 907-784-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHODA JENSEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-784-3275