Provider Demographics
NPI:1326262890
Name:THE SALVATION ARMY BOOTH MEMORIAL CARES FOR KIDS NURSERY
Entity Type:Organization
Organization Name:THE SALVATION ARMY BOOTH MEMORIAL CARES FOR KIDS NURSERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISIONAL FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-339-3406
Mailing Address - Street 1:143 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3618
Mailing Address - Country:US
Mailing Address - Phone:907-339-3406
Mailing Address - Fax:907-276-2611
Practice Address - Street 1:3600 E 20TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3416
Practice Address - Country:US
Practice Address - Phone:907-279-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11806322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKBR0020Medicaid