Provider Demographics
NPI:1659644508
Name:MARY JANES HOUSE OF HEALING LLC
Entity Type:Organization
Organization Name:MARY JANES HOUSE OF HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STRYKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-232-2725
Mailing Address - Street 1:634 S BAILEY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6360
Mailing Address - Country:US
Mailing Address - Phone:907-746-1815
Mailing Address - Fax:907-746-1816
Practice Address - Street 1:550 S ALASKA ST STE 104C
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6371
Practice Address - Country:US
Practice Address - Phone:907-745-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty