Provider Demographics
NPI:1114786050
Name:JOEY'S PLACE LLC
Entity Type:Organization
Organization Name:JOEY'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-229-2402
Mailing Address - Street 1:PO BOX 872861
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2861
Mailing Address - Country:US
Mailing Address - Phone:907-229-2402
Mailing Address - Fax:
Practice Address - Street 1:1914 E CARNEY RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9007
Practice Address - Country:US
Practice Address - Phone:907-229-2402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health