Provider Demographics
NPI:1679603740
Name:MAT-SU ACTIVITY AND RESPITE CENTER
Entity Type:Organization
Organization Name:MAT-SU ACTIVITY AND RESPITE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-8622
Mailing Address - Street 1:951 E BOGARD RD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7113
Mailing Address - Country:US
Mailing Address - Phone:907-357-8622
Mailing Address - Fax:907-357-8624
Practice Address - Street 1:951 E BOGARD RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7113
Practice Address - Country:US
Practice Address - Phone:907-357-8622
Practice Address - Fax:907-357-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services