Provider Demographics
NPI:1114223476
Name:J.C FAITH OPEN ARMS #2
Entity Type:Organization
Organization Name:J.C FAITH OPEN ARMS #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEWBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-602-0818
Mailing Address - Street 1:8301 E 11TH CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2210
Mailing Address - Country:US
Mailing Address - Phone:907-332-4730
Mailing Address - Fax:907-332-4731
Practice Address - Street 1:8301 E 11TH CT UNIT 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2210
Practice Address - Country:US
Practice Address - Phone:907-332-4730
Practice Address - Fax:907-332-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK941631320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness