Provider Demographics
NPI:1124741665
Name:YAKUTAT COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:YAKUTAT COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-784-3275
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:YAKUTAT
Mailing Address - State:AK
Mailing Address - Zip Code:99689-0112
Mailing Address - Country:US
Mailing Address - Phone:907-784-3275
Mailing Address - Fax:907-784-3263
Practice Address - Street 1:112 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:YAKUTAT
Practice Address - State:AK
Practice Address - Zip Code:99689
Practice Address - Country:US
Practice Address - Phone:907-784-3275
Practice Address - Fax:907-784-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)