Provider Demographics
NPI:1679704712
Name:THE CHILDREN'S PLACE
Entity Type:Organization
Organization Name:THE CHILDREN'S PLACE
Other - Org Name:THE CHILDREN'S PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BAYLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-5157
Mailing Address - Street 1:PO BOX 871788
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687
Mailing Address - Country:US
Mailing Address - Phone:907-357-5157
Mailing Address - Fax:907-357-5159
Practice Address - Street 1:1021 N LUCILLE ST
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6405
Practice Address - Country:US
Practice Address - Phone:907-357-5157
Practice Address - Fax:907-357-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK271872251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1999Medicaid