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).
| 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 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | ========= | AK | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | MH2770 | 05 |
| Other Name | Type Code |
|---|---|
| ILL Learning Lab | 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 |
| 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 |
| 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 |
209 FORTY MILE AVE SUITE #100 |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701 |
| 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 |
| 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 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 |
|---|---|---|---|---|
| 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 | ||||
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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.