NPIMap

Organization Active NPI

Mat-Su Services for Children & Adults

  • Case Management Agency
  • Wasilla, AK
National Provider Identifier
1104950419
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
403503 Issued in AK
Legal business name
MAT-SU SERVICES FOR CHILDREN & ADULTS
Practice address
1225 W Spruce Ave
Wasilla, AK 99654-5326
Phone
(907) 352-1200
Fax
(907) 352-1249
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kaleb Johnson
Title
Executive Director
Phone
(907) 352-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 403503 AK Primary

Addresses

Primary practice location

1225 W Spruce Ave
Wasilla, AK 99654-5326

Mailing address

1225 W Spruce Ave
Wasilla, AK 99654-5326
Phone (907) 352-1200

Other identifiers 1

IdentifierTypeStateIssuer
CMG745MedicaidAK

National Provider Directory

National Provider Directory
Tax ID family
Mat-Su Services for Children Adults4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764028800000",
    "number": "1104950419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545326",
            "telephone_number": "907-352-1200",
            "fax_number": "907-352-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W SPRUCE AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996545326",
            "telephone_number": "907-352-1200",
            "fax_number": "907-352-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAT-SU SERVICES FOR CHILDREN & ADULTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KALEB",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-352-1200"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AK",
            "license": "403503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMG745",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.