Montana Creek Assisted Living Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

100437 Issued in AK

Legal business name

MONTANA CREEK ASSISTED LIVING HOME

Practice address

19205 E Future Rd
Talkeetna, AK 99676

Phone

(907) 354-3441

NPI assigned

May 11, 2017

Organization subpart

No

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

Authorized official

Name

Tina McCluskeyNPI 1124544523

Title

Administrator

Phone

(907) 354-3441

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tina McCluskey

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Talkeetna, AK
  • NPI 1124544523

  Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD (past) Authorized official

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1255867263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735",
            "city": "WILLOW",
            "state": "AK",
            "postal_code": "996880735",
            "telephone_number": "907-354-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19205 E FUTURE RD",
            "city": "TALKEETNA",
            "state": "AK",
            "postal_code": "99676",
            "telephone_number": "907-354-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTANA CREEK ASSISTED LIVING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "MCCLUSKEY",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-354-3441"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AK",
            "license": "100437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Jean Korta, MED
• Peggy Irene Marsh, R.N.
• Tina McCluskey
• Helen Michaelson, LMSW
• David Michels, RN
• Mark G Moren, PHD
• Jayme L S Moudy-Ferrier, LCSW
• Michael Randell, DDS
• Rewilding Behavioral Health Services
• Sharla Rose, LMT

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Talkeetna, AK
• Providers in Talkeetna, AK by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.