NPIMap

Organization Active NPI

Maniilaq Association

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Kotzebue, AK
National Provider Identifier
1811199169
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
400278 Issued in AK
Legal business name
MANIILAQ ASSOCIATION
Practice address
572 Friends Way
Kotzebue, AK 99752
Phone
(907) 442-7582
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Karen Denise Sours
Title
Program Coordinator
Phone
(907) 442-7582

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 400278 AK Primary

Addresses

Primary practice location

572 Friends Way
Kotzebue, AK 99752

Mailing address

PO Box 256
Kotzebue, AK 99752-0256
Phone (907) 442-3311

Other identifiers 1

IdentifierTypeStateIssuer
BR0023MedicaidAK

National Provider Directory

National Provider Directory
Tax ID family
Buckland Clinic45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 1

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": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811199169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 256",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "997520256",
            "telephone_number": "907-442-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 FRIENDS WAY",
            "city": "KOTZEBUE",
            "state": "AK",
            "postal_code": "99752",
            "telephone_number": "907-442-7582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANIILAQ ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOURS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "907-442-7582",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AK",
            "license": "400278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BR0023",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kotzebue, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.