Provider Demographics
NPI:1295170348
Name:POLARIS HOUSE INC.
Entity type:Organization
Organization Name:POLARIS HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-780-6775
Mailing Address - Street 1:PO BOX 21661
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99802-1661
Mailing Address - Country:US
Mailing Address - Phone:907-780-6775
Mailing Address - Fax:907-780-6774
Practice Address - Street 1:434 WILLOUGHBY AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1724
Practice Address - Country:US
Practice Address - Phone:907-780-6775
Practice Address - Fax:907-780-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK914750251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health