1073841789 NPI number — SET FREE ALASKA, INC.

Table of content: (NPI 1073841789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073841789 NPI number — SET FREE ALASKA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SET FREE ALASKA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073841789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 876741
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASILLA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99687-6741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-373-4732
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7010 E BOGARD RD BLDG 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASILLA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99654-4711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-373-4732
Provider Business Practice Location Address Fax Number:
907-746-4749
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
907-982-1054

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1706868 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1679665 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1702627 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 602-239-20011 . This is a "STATE OF ALASKA GRANT" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1585308 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 602-208-20052 . This is a "STATE OF ALASKA GRANT" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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