Provider Demographics
NPI:1760715551
Name:COVENANT HOUSE ALASKA
Entity Type:Organization
Organization Name:COVENANT HOUSE ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-272-1255
Mailing Address - Street 1:4946 VANCE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5651
Mailing Address - Country:US
Mailing Address - Phone:907-884-2150
Mailing Address - Fax:
Practice Address - Street 1:609 F ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3533
Practice Address - Country:US
Practice Address - Phone:907-272-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management