Provider Demographics
NPI:1447571492
Name:ALASKA MILITARY YOUTH ACADEMY
Entity Type:Organization
Organization Name:ALASKA MILITARY YOUTH ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:907-384-6141
Mailing Address - Street 1:CAMP CARROLL BLDG 60710
Mailing Address - Street 2:POB 5727
Mailing Address - City:FORT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-0727
Mailing Address - Country:US
Mailing Address - Phone:907-384-6017
Mailing Address - Fax:907-384-6007
Practice Address - Street 1:CAMP CARROLL BLDG 60710
Practice Address - Street 2:POB 5727
Practice Address - City:FORT RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505-0727
Practice Address - Country:US
Practice Address - Phone:907-384-6115
Practice Address - Fax:907-384-6045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALASKA DEPT OF MILITARY & VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)