NPIMap

Organization Active NPI

Sprout Family Services, Inc.

  • Case Management Agency
  • Homer, AK
National Provider Identifier
1720105992
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
SPROUT FAMILY SERVICES, INC.
Practice address
3691 Ben Walters LN Ste 4
Homer, AK 99603-7750
Phone
(907) 235-6044
Fax
(907) 235-2644
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

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

Authorized official

Name
Jillian Lush
Title
Executive Director
Phone
(907) 235-6044

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary
Developmentally Disabled Services Day Training Agency 251C00000X

Addresses

Primary practice location

3691 Ben Walters LN Ste 4
Homer, AK 99603-7750

Mailing address

3691 Ben Walters LN Ste 4
Homer, AK 99603-7750
Phone (907) 235-6044

Other identifiers 2

IdentifierTypeStateIssuer
TC2625MedicaidAK
CMG117MedicaidAK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Outpatient physical therapy / speech pathology certification: CCN 026525

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SPROUT FAMILY SERVICES
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Mar 13, 1997
Last certification
Jun 6, 2023
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
3691 Ben Walters Lane, #4
Homer, AK 99603

National Provider Directory

National Provider Directory

Locations

3691 Ben Walters Ln
Ste 4
Homer, AK 99603
Phone (907) 235-6044

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323043200000",
    "number": "1720105992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3691 BEN WALTERS LN STE 4",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037750",
            "telephone_number": "907-235-6044",
            "fax_number": "907-235-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3691 BEN WALTERS LN STE 4",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037750",
            "telephone_number": "907-235-6044",
            "fax_number": "907-235-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPROUT FAMILY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2011-12-05",
        "status": "A",
        "authorized_official_last_name": "LUSH",
        "authorized_official_first_name": "JILLIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-235-6044"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TC2625",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMG117",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer, AK

Sources for this page

Verify at the official NPI Registry.