Provider Demographics
NPI:1033835228
Name:MORNINGSTAR THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:MORNINGSTAR THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT-RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:907-354-4938
Mailing Address - Street 1:PO BOX 876106
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6106
Mailing Address - Country:US
Mailing Address - Phone:907-232-9103
Mailing Address - Fax:907-357-1870
Practice Address - Street 1:3315 HILAND DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4077
Practice Address - Country:US
Practice Address - Phone:907-354-4938
Practice Address - Fax:907-357-1870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1023592Medicaid