Provider Demographics
NPI:1972637361
Name:ALASKA BAPTIST FAMILY SERVICES
Entity Type:Organization
Organization Name:ALASKA BAPTIST FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:907-349-2222
Mailing Address - Street 1:1600 OMALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-7301
Mailing Address - Country:US
Mailing Address - Phone:907-349-2222
Mailing Address - Fax:907-349-5335
Practice Address - Street 1:1600 OMALLEY RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-7301
Practice Address - Country:US
Practice Address - Phone:907-349-2222
Practice Address - Fax:907-349-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK400158322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKBR0001Medicare ID - Type UnspecifiedALASKA MEDICAID PROVIDER