Provider Demographics
NPI:1700422029
Name:SET FREE ALASKA, INC.
Entity Type:Organization
Organization Name:SET FREE ALASKA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-982-1054
Mailing Address - Street 1:PO BOX 876741
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6741
Mailing Address - Country:US
Mailing Address - Phone:908-373-4732
Mailing Address - Fax:
Practice Address - Street 1:7010 E BOGARD RD BLDG 2
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-4711
Practice Address - Country:US
Practice Address - Phone:907-373-4732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1696864Medicaid