PRESBYTERIAN HOSPITALITY HOUSE (NPI# 1326396821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326396821 |
| Entity Type | Organization |
| Organization Name | PRESBYTERIAN HOSPITALITY HOUSE |
| Practice Address |
2771 E Hiawatha Dr Wasilla AK 99654-2853 |
| Mailing Address |
209 Forty Mile Ave Fairbanks AK 99701-3110 |
| Practice Telephone | 9074566445 |
| Practice Fax Number | 9074566402 |
| Mailing Telephone | 9074566445 |
| Mailing Fax Number | 9074566402 |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |
| Authorized Official Name | DRENDA M TIGNER (CEO) |
| Authorized Official Telephone | 9074566445 |
| Authorized Official Credential | B.A., M.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 1639 | AK | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MH2770 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598013096 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 1145 W Granville St, Palmer, AK 99645-7118 | 2012-08-15 |
| 1639425812 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 6969 S Hood Ct, Wasilla, AK 99624 | 2012-07-25 |
| 1962619643 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 209 Forty Mile Ave Ste 100, Fairbanks, AK 99701-3110 | 2007-05-16 |
| 1710108535 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 283 Bias Dr, Fairbanks, AK 99712-2502 | 2007-05-01 |
| 1538380357 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 1260 Nordin Dr, Fairbanks, AK 99709-6808 | 2007-05-01 |
| 1629299441 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 3809 Mitchell Ave, Fairbanks, AK 99709-4638 | 2007-05-01 |
| 1457572299 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 1260 Silverberry Dr, Fairbanks, AK 99712-2736 | 2007-05-01 |
| 1275754012 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 7609 Chena Hot Springs Rd, Fairbanks, AK 99712 | 2007-05-01 |
| 1871624536 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 209 Forty Mile Ave, Fairbanks, AK 99701-3110 | 2007-03-07 |
| 1609097476 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 209 Forty Mile Ave, Suite #100, Fairbanks, AK 99701 | 2007-05-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRESBYTERIAN HOSPITALITY HOUSE INC | 209 Forty Mile Ave Ste 100, Fairbanks, AK 99701-3110 |
| Street Address |
2771 E HIAWATHA DR |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-2853 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639425812 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 6969 S Hood Ct, Wasilla, AK 99624 | 2012-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982228177 | Juneau Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8460 Rainbow Row, Juneau, AK 99801-9041 | 2020-06-03 |
| 1447874631 | Juneau Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 10815 Black Bear Rd, Juneau, AK 99801-8783 | 2020-06-03 |
| 1043834245 | Juneau Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 10685 Mendenhall Loop Rd, Juneau, AK 99801 | 2020-06-03 |
| 1295359511 | Juneau Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 10801 Black Bear Rd, Juneau, AK 99801 | 2020-06-02 |
| 1700400033 | Juneau Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 10685 Mendenhall Lp Rd, Juneau, AK 99801 | 2020-06-02 |
| 1417502998 | Christopher Robert Jackson | Residential Treatment Facility, Emotionally Disturbed Children | 1502 Liatris Ln, North Pole, AK 99705-5082 | 2019-08-01 |
| 1598013096 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 1145 W Granville St, Palmer, AK 99645-7118 | 2012-08-15 |
| 1457528366 | Boys and Girls Home of Alaska | Residential Treatment Facility, Emotionally Disturbed Children | 3101 Lathrop Street, Fairbanks, AK 99707-0870 | 2008-05-09 |
| 1073701033 | Alaska Family Services Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1825 S Chugach Street, Palmer, AK 99645 | 2007-10-04 |
| 1811199169 | Maniilaq Association | Residential Treatment Facility, Emotionally Disturbed Children | 572 Friends Way, Kotzebue, AK 99752 | 2007-05-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.