Active NPI
Colleen McNulty
- Physical Disabilities Residential Treatment Facility
- Kenai, AK
National Provider Identifier
1326460387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Disabilities Residential Treatment Facility
- License
- 101027
- Practice address
- 701 North Forest St.
Kenai, AK 99611 - Phone
- (907) 335-2052
- Fax
- (907) 335-2051
- NPI assigned
- Jan 10, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Disabilities Residential Treatment Facility | 320700000X | 101027 | AK | Primary |
Addresses
Primary practice location
701 North Forest St.
Kenai, AK 99611
Mailing address
701 North Forest St.
Kenai, AK 99611
Phone (907) 335-2052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101027 | AK | MD | Physical Disabilities Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389312000000",
"number": "1326460387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 NORTH FOREST ST.",
"city": "KENAI",
"state": "AK",
"postal_code": "99611",
"telephone_number": "907-335-2052",
"fax_number": "907-335-2051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 NORTH FOREST ST.",
"city": "KENAI",
"state": "AK",
"postal_code": "99611",
"telephone_number": "907-335-2052",
"fax_number": "907-335-2051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCNULTY",
"first_name": "COLLEEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-10",
"last_updated": "2014-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "320700000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Physical Disabilities",
"state": "AK",
"license": "101027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenai, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.