Provider Demographics
NPI:1992929111
Name:NIKISKI SENIOR CITIZENS, INC.
Entity type:Organization
Organization Name:NIKISKI SENIOR CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGSTROM-SANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-776-7654
Mailing Address - Street 1:PO BOX 6973
Mailing Address - Street 2:
Mailing Address - City:NIKISKI
Mailing Address - State:AK
Mailing Address - Zip Code:99635-6973
Mailing Address - Country:US
Mailing Address - Phone:907-776-7654
Mailing Address - Fax:
Practice Address - Street 1:50810 ISLAND LAKE ROAD
Practice Address - Street 2:
Practice Address - City:NIKISKI
Practice Address - State:AK
Practice Address - Zip Code:99635
Practice Address - Country:US
Practice Address - Phone:907-776-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC4377Medicaid