Provider Demographics
NPI:1386398881
Name:NORTHWAY FAMILY HEALTHCARE
Entity type:Organization
Organization Name:NORTHWAY FAMILY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:MAKA
Authorized Official - Last Name:NORTHWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:907-225-4325
Mailing Address - Street 1:130 CARLANNA LAKE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5669
Mailing Address - Country:US
Mailing Address - Phone:907-225-4325
Mailing Address - Fax:907-225-4326
Practice Address - Street 1:130 CARLANNA LAKE RD STE 201
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5669
Practice Address - Country:US
Practice Address - Phone:907-225-4325
Practice Address - Fax:907-225-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1573464Medicaid