Provider Demographics
NPI:1457528366
Name:BOYS AND GIRLS HOME OF ALASKA
Entity Type:Organization
Organization Name:BOYS AND GIRLS HOME OF ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:907-479-0560
Mailing Address - Street 1:3101 LATHROP STREET
Mailing Address - Street 2:PO BOX 70870
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0870
Mailing Address - Country:US
Mailing Address - Phone:907-479-0560
Mailing Address - Fax:907-479-0560
Practice Address - Street 1:3101 LATHROP STREET
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99707-0870
Practice Address - Country:US
Practice Address - Phone:907-479-0560
Practice Address - Fax:907-479-0560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOYS AND GIRLS HOME AND FAMILY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children