Provider Demographics
NPI:1467669150
Name:STATE OF ALASKA DEPARTMENT OF ADMINISTRATION
Entity Type:Organization
Organization Name:STATE OF ALASKA DEPARTMENT OF ADMINISTRATION
Other - Org Name:DHSS OFFICES OF CHILDREN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING TECHNICIAN II
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-465-5280
Mailing Address - Street 1:PO BOX 110630
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99811-0630
Mailing Address - Country:US
Mailing Address - Phone:907-465-5280
Mailing Address - Fax:907-465-3190
Practice Address - Street 1:130 SEWARD ST
Practice Address - Street 2:SUITE 308
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-2102
Practice Address - Country:US
Practice Address - Phone:907-465-5280
Practice Address - Fax:907-465-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKBR0021Medicaid