PRESBYTERIAN HOSPITALITY HOUSE (NPI# 1598013096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598013096 |
| Entity Type | Organization |
| Organization Name | PRESBYTERIAN HOSPITALITY HOUSE |
| Other Organization Name | GRANVILE HOME |
| Practice Address |
1145 W Granville St Palmer AK 99645-7118 |
| 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 | 2012-11-01 |
| 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 |
| Other Name | Type Code |
|---|---|
| Granvile Home | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326396821 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 2771 E Hiawatha Dr, Wasilla, AK 99654-2853 | 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 |
1145 W GRANVILLE ST |
| City | PALMER |
| State | AK |
| Zip Code | 99645-7118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295357135 | Kasey M Flintoft | Occupational Therapist | 7200 E. Jim Cottrell Cir, Palmer, AK 99645 | 2020-05-14 |
| 1629601471 | Courtney Randol | Licensed Practical Nurse | 14405 E Pace Dr., Palmer, AK 99645 | 2020-02-20 |
| 1689213092 | Valerie Anne Delaune | Acupuncturist | 9693 N. Little Otter Dr., Palmer, AK 99645 | 2020-01-02 |
| 1003464512 | Alaskan Sunrise Behavioral Health, L.L.C. | Clinic/Center | 14460 E. Pace Dr., Palmer, AK 99645 | 2019-08-28 |
| 1548814718 | Maple Springs of Palmer Snf Holdings, LLC | Skilled Nursing Facility | 12130 E Maple Springs Way, Palmer, AK 99645 | 2019-07-26 |
| 1952868655 | Carla Beth Kelly | Physical Therapist | 7200 Jim Cottrell Circle, Palmer, AK 99645 | 2019-02-28 |
| 1366938375 | Wendy S Page | Behavior Technician | 7200 E Jim Cottrell, Wasilla, AK 99645 | 2018-07-03 |
| 1154845170 | Sarah Elizabeth Gilliland | Occupational Therapist | 7200 E Jim Cottrell Circle, Palmer, AK 99645 | 2017-08-01 |
| 1558885137 | Garland Brooks | Massage Therapist | 1934 Prospect Dr, Palmer, AK 99645 | 2017-07-26 |
| 1386165009 | Sommer Dawn Nielsen | Massage Therapist | 3566 N Mars Ave., Palmer, AK 99645 | 2017-07-03 |
| Find all providers in zip 99645 | ||||
| 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 |
|---|---|---|---|---|
| 1073701033 | Alaska Family Services Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1825 S Chugach Street, Palmer, AK 99645 | 2007-10-04 |
| 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 |
| 1326396821 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 2771 E Hiawatha Dr, Wasilla, AK 99654-2853 | 2012-08-15 |
| 1639425812 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 6969 S Hood Ct, Wasilla, AK 99624 | 2012-07-25 |
| 1457528366 | Boys and Girls Home of Alaska | Residential Treatment Facility, Emotionally Disturbed Children | 3101 Lathrop Street, Fairbanks, AK 99707-0870 | 2008-05-09 |
| 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.