Provider Demographics
NPI:1578196192
Name:HAB ACADEMY LLC
Entity Type:Organization
Organization Name:HAB ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:ALAINE
Authorized Official - Last Name:WOITEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-841-5911
Mailing Address - Street 1:PO BOX 874852
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4314 S PINNACLE PEAK DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0707
Practice Address - Country:US
Practice Address - Phone:907-841-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health