Provider Demographics
NPI:1023832045
Name:MAT SU YOUTH HOUSING
Entity type:Organization
Organization Name:MAT SU YOUTH HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LING
Authorized Official - Suffix:
Authorized Official - Credentials:CDCS
Authorized Official - Phone:907-373-4357
Mailing Address - Street 1:300 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7042
Mailing Address - Country:US
Mailing Address - Phone:907-373-4357
Mailing Address - Fax:
Practice Address - Street 1:800 N WASILLA FISHHOOK RD.
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility