NPIMap

Organization Active NPI

Presbyterian Hospitality House

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Fairbanks, AK
National Provider Identifier
1962619643
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
PRESBYTERIAN HOSPITALITY HOUSE
Practice address
209 Forty Mile Ave Ste 100
Fairbanks, AK 99701-3110
Phone
(907) 456-6445
Fax
(907) 456-6402
NPI assigned
May 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Drenda Tigner, MA
Title
Excutive Director
Phone
(907) 456-6445

Specialties & licenses 1

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

Addresses

Primary practice location

209 Forty Mile Ave Ste 100
Fairbanks, AK 99701-3110

Mailing address

209 Forty Mile Ave Ste 100
Fairbanks, AK 99701-3110
Phone (907) 456-6445

Other identifiers 2

IdentifierTypeStateIssuer
MH2770MedicaidAK
BR-0024OtherAKBR NUMBER

Other names 1

  • 7th Ave Home 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.

Locations

209 Forty Mile Ave
Ste 100
Fairbanks, AK 99701
Phone (907) 456-6445

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1962619643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 FORTY MILE AVE STE 100",
            "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": "209 FORTY MILE AVE STE 100",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997013110",
            "telephone_number": "907-456-6445",
            "fax_number": "907-456-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOSPITALITY HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TIGNER",
        "authorized_official_first_name": "DRENDA",
        "authorized_official_title_or_position": "EXCUTIVE DIRECTOR",
        "authorized_official_telephone_number": "907-456-6445",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH2770",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BR NUMBER",
            "identifier": "BR-0024",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "7th Ave Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.