NPIMap

Organization Active NPI

Presbyterian Hospitality House

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Wasilla, AK
National Provider Identifier
1639425812
Registry record updated Nov 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
1639 Issued in AK
Legal business name
PRESBYTERIAN HOSPITALITY HOUSE
Practice address
6969 S Hood CT
Wasilla, AK 99624
Phone
(907) 357-0487
Fax
(907) 376-6402
NPI assigned
Jul 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2012

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

Authorized official

Name
Drenda M Tigner, B.A., M.A.
Title
Ceo
Phone
(907) 456-6445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 1639 AK Primary

Addresses

Primary practice location

6969 S Hood CT
Wasilla, AK 99624

Mailing address

209 Forty Mile Ave
Fairbanks, AK 99701-3110
Phone (907) 456-6445

Other identifiers 1

IdentifierTypeStateIssuer
MH2770MedicaidAK

Other names 1

  • Hood Ct Other name

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Hospitality House11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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": "1343174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1639425812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 FORTY MILE AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013110",
            "telephone_number": "907-456-6445",
            "fax_number": "907-456-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6969 S HOOD CT",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99624",
            "telephone_number": "907-357-0487",
            "fax_number": "907-376-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOSPITALITY HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-25",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "TIGNER",
        "authorized_official_first_name": "DRENDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-456-6445",
        "authorized_official_credential": "B.A., M.A."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AK",
            "license": "1639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH2770",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hood Ct",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 5, 2012; 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.