Provider Demographics
NPI:1073717047
Name:TANANA CHIEFS CONFENERCE
Entity type:Organization
Organization Name:TANANA CHIEFS CONFENERCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-8251
Mailing Address - Street 1:201 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4848
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3852
Practice Address - Street 1:201 1ST AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4848
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG190Medicaid
AKHC1919Medicaid