PRESBYTERIAN HOSPITALITY HOUSE (NPI# 1639425812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639425812 |
| Entity Type | Organization |
| Organization Name | PRESBYTERIAN HOSPITALITY HOUSE |
| Other Organization Name | HOOD CT |
| Practice Address |
6969 S Hood Ct Wasilla AK 99624 |
| Mailing Address |
209 Forty Mile Ave Fairbanks AK 99701-3110 |
| Practice Telephone | 9073570487 |
| Practice Fax Number | 9073766402 |
| Mailing Telephone | 9074566445 |
| Mailing Fax Number | 9074566402 |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-11-05 |
| 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 |
|---|---|
| Hood Ct | 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 |
| 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 |
6969 S HOOD CT |
| City | WASILLA |
| State | AK |
| Zip Code | 99624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427513845 | Rachelle Aga | Community Health Worker | 127 Main St., Larsen Bay, AK 99624 | 2019-02-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366040826 | Amanda Johnson | Technician | 1401 S Seward Meridian Pkwy # Ab, Wasilla, AK 99654-8312 | 2020-10-15 |
| 1942807862 | Turning Leaf Literacy Center, LLC | Clinic/Center | 690 E Susitna Ave, Wasilla, AK 99654-8124 | 2020-10-04 |
| 1700493434 | Elisabeth Lewis | Behavior Technician | 777 N Crusey St, Wasilla, AK 99654-7100 | 2020-09-27 |
| 1376150169 | Emily Kristine Crager | Behavior Technician | 777 N Crusey St Ste B108, Wasilla, AK 99654-7101 | 2020-09-25 |
| 1558977637 | Beyond Limits Pediatrics, LLC | Occupational Therapist | 3320 E Beech Way Unit 2, Wasilla, AK 99654-7417 | 2020-09-23 |
| 1619583838 | Jennifer Clare Lewis | Counselor | 291 E Swanson Ave Ste 100, Wasilla, AK 99654-7004 | 2020-09-22 |
| 1558977108 | Bryce Matthew Christianson | Behavior Technician | 300 W Swanson Ave # 512, Wasilla, AK 99654-6844 | 2020-09-18 |
| 1427661974 | Scott Dean Heim | Durable Medical Equipment & Medical Supplies | 1051 E Bogard Rd Ste 6, Wasilla, AK 99654-7174 | 2020-08-25 |
| 1457963308 | Brittany Shawn Carie | Student in an Organized Health Care Education/Training Program | 2524 S Paddock Dr, Wasilla, AK 99654-8451 | 2020-08-21 |
| 1336751247 | Midwifery Options LLC | Advanced Practice Midwife | 2454 W Ben Hogan Ave Apt 4, Wasilla, AK 99623-0042 | 2020-08-21 |
| Find all providers in WASILLA | ||||
| 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 |
|---|---|---|---|---|
| 1326396821 | Presbyterian Hospitality House | Residential Treatment Facility, Emotionally Disturbed Children | 2771 E Hiawatha Dr, Wasilla, AK 99654-2853 | 2012-08-15 |
| 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.