PRESBYTERIAN HOSPITALITY HOUSE


Address: 209 Forty Mile Ave, Suite #100, Fairbanks, AK 99701
Phone: 9074566445

PRESBYTERIAN HOSPITALITY HOUSE (NPI# 1609097476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1609097476
Entity Type Organization
Organization Name PRESBYTERIAN HOSPITALITY HOUSE
Other Organization Name ILL LEARNING LAB
Practice Address 209 Forty Mile Ave
Suite #100
Fairbanks
AK 99701
Practice Telephone 9074566445
Practice Fax Number 9074566402
Mailing Telephone 9074566445
Mailing Fax Number 9074566402
Enumeration Date 2007-05-01
Last Update Date 2018-06-20
Authorized Official Name MS. DRENDA TIGNER (EXCUTIVE DIRECTOR)
Authorized Official Telephone 9074566445
Authorized Official Credential MA
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 322D00000X Residential Treatment Facility, Emotionally Disturbed Children ========= AK Residential Treatment Facilities

Other Provider Identifier

State Issuer Identifier Type Code
AK MH2770 05

Other Provider/Organization Names

Other Name Type Code
ILL Learning Lab Other Name - Individual/Organization

Other Provider IDs and Locations

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
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

Other Data Sources

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

Office Location

Street Address 209 FORTY MILE AVE
SUITE #100
City FAIRBANKS
State AK
Zip Code 99701

Providers in the same location

NPI Name Taxonomy Address Enumeration
1871624536 Presbyterian Hospitality House Residential Treatment Facility, Emotionally Disturbed Children 209 Forty Mile Ave, Fairbanks, AK 99701-3110 2007-03-07

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1659984987 Resource Center for Parents & Children, Inc. Social Worker 726 26th Ave, Suite #2, Fairbanks, AK 99701 2020-08-26
1134738982 Aaron Paul Sarauer Behavior Technician 3121 Lathrop St., Fairbanks, AK 99701 2020-07-28
1437715505 Fabienne Rose Marie Siddall Case Manager/Care Coordinator 122 1st Avenue, Fairbanks, AK 99701 2019-05-14
1902461957 Jacqueline Marie Rahm Counselor Family Centered Services of Alaska - Rtc, 3101 Lathrop St., Fairbanks, AK 99701 2019-05-06
1821588989 Corrie Wilson Nurse Practitioner 1025 Barnette Street, Fairbanks, AK 99701 2018-05-15
1922519305 Sarishma Sangeeta Lal Registered Nurse 815 2nd Ave Ste 122, Fairbanks, AK 99701 2017-10-12
1245690569 Christine L Simko Naturopath 1275 Sadler Way, Ste 100 Rm 147, Fairbanks, AK 99701 2016-02-29
1932581600 Jennifer Davis Registered Nurse 1025 West Barnette St., Fairbanks, AK 99701 2015-06-18
1700272705 John D. Zipperer Jr Md, LLC Clinic/Center 751 Old Richardson Hwy., Fairbanks, AK 99701 2015-04-07
1578957460 Mara Justine Becker Physician Assistant 1717 W. Cowles St, Fairbanks, AK- ALASKA 99701 2015-03-27
Find all providers in zip 99701

Taxonomy Information

Taxonomy Code 322D00000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Emotionally Disturbed Children

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1457528366 Boys and Girls Home of Alaska Residential Treatment Facility, Emotionally Disturbed Children 3101 Lathrop Street, Fairbanks, AK 99707-0870 2008-05-09
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
1427602358 Deborah Ann Kekoni Residential Treatment Facility, Emotionally Disturbed Children 3101 Lathrop St, Fairbanks, AK 99701-7426 2019-07-29
1295389120 Jared Michael Anderson Residential Treatment Facility, Emotionally Disturbed Children 3101 Lathrop St, Fairbanks, AK 99701-7426 2019-07-29
Find all providers in FAIRBANKS

Competitor

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City FAIRBANKS
Zip Code 99701

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Dataset Information

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.

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