Provider Demographics
NPI:1881852663
Name:MORNING STAR RANCH
Entity Type:Organization
Organization Name:MORNING STAR RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COLBERT SR.
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:907-978-9890
Mailing Address - Street 1:PO BOX 80711
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0711
Mailing Address - Country:US
Mailing Address - Phone:907-455-6772
Mailing Address - Fax:907-374-4480
Practice Address - Street 1:2757 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3751
Practice Address - Country:US
Practice Address - Phone:907-455-6772
Practice Address - Fax:907-374-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCMG764251B00000X
AKCM7641251B00000X
AKHC7641251C00000X, 347C00000X, 385HR2060X
AK251C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC7641Medicaid
AK1004993Medicaid