Provider Demographics
NPI:1578109120
Name:JETT MORGAN TREATMENT SERVICES, LLC
Entity Type:Organization
Organization Name:JETT MORGAN TREATMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:AAS, CDC II, BHC II
Authorized Official - Phone:907-677-7709
Mailing Address - Street 1:400 W TUDOR RD STE A400
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6652
Mailing Address - Country:US
Mailing Address - Phone:907-677-7709
Mailing Address - Fax:907-677-7095
Practice Address - Street 1:4701 BUSINESS PARK BLVD STE J20
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7170
Practice Address - Country:US
Practice Address - Phone:907-677-7709
Practice Address - Fax:907-677-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1698507Medicaid