PRESBYTERIAN HOSPITALITY HOUSE (NPI# 1275754012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275754012 |
| Entity Type | Organization |
| Organization Name | PRESBYTERIAN HOSPITALITY HOUSE |
| Other Organization Name | BOYS FARM |
| Practice Address |
7609 Chena Hot Springs Rd Fairbanks AK 99712 |
| Mailing Address |
209 Forty Mile Ave Fairbanks AK 99701-3110 |
| Practice Telephone | 9074566446 |
| Practice Fax Number | 9074566402 |
| Mailing Telephone | 9074566446 |
| Mailing Fax Number | 9074566402 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-11-05 |
| Authorized Official Name | 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 |
|---|---|
| Boys Farm | 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 |
| 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 |
7609 CHENA HOT SPRINGS RD |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295216687 | Janet Lynn Juenke | Massage Therapist | 615 O'leary Rd, Fairbanks, AK 99712 | 2018-08-24 |
| 1730618422 | Melody Waldroup | Massage Therapist | 845 Birch Hill Rd, Fairbanks, AK 99712 | 2017-06-07 |
| 1154715928 | Relax Your Mind, Body and Soul | Clinic/Center | 559 Golden Morn St, Fairbanks, AK 99712 | 2015-03-19 |
| 1295045508 | Kelly Eggleston | Case Manager/Care Coordinator | 764 Adventure Road, Fairbanks, AK 99712 | 2010-10-20 |
| 1588871628 | Country Estates Inc | Assisted Living Facility | 240 Peregrine Drive, Fairbanks, AK 99712 | 2007-05-17 |
| 1750717922 | Moveit Physical Therapy, LLC | Clinic/Center | 665 Aspen Heights Dr, Fairbanks, AK 99712-1111 | 2013-09-19 |
| 1144669052 | Jessica Revells | Occupational Therapy Assistant | 734 Manchester Loop, Fairbanks, AK 99712-1120 | 2013-06-25 |
| 1134455397 | Farmers Loop Home, LLC | Assisted Living Facility | 1002 Senate Loop, 1002 Senate Loop, Fairbanks, AK 99712-1130 | 2009-10-22 |
| 1417227752 | Viola L Mccain | Social Worker | 1335 Skyline Dr, Fairbanks, AK 99712-1151 | 2012-01-04 |
| 1043462062 | Shirley Harris | Physical Therapy Assistant | 324 Skyridge Dr, Fairbanks, AK 99712-1205 | 2008-10-22 |
| Find all providers in zip 99712 | ||||
| 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 |
| 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 |
| 1841844933 | David Christensen | Residential Treatment Facility, Emotionally Disturbed Children | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2019-07-28 |
| 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.