Provider Demographics
NPI:1346661030
Name:THE HICKOK ALH
Entity Type:Organization
Organization Name:THE HICKOK ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:HICKOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-274-0060
Mailing Address - Street 1:6074 DONCASTER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3234
Mailing Address - Country:US
Mailing Address - Phone:907-274-0060
Mailing Address - Fax:
Practice Address - Street 1:6074 DONCASTER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3234
Practice Address - Country:US
Practice Address - Phone:907-274-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services