Provider Demographics
NPI:1649490236
Name:STATE OF ALASKA, DEPARTMENT OF H&SS, DIVISION OF JUVENILE JUSTICE
Entity type:Organization
Organization Name:STATE OF ALASKA, DEPARTMENT OF H&SS, DIVISION OF JUVENILE JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-465-2112
Mailing Address - Street 1:PO BOX 110635
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99811-0635
Mailing Address - Country:US
Mailing Address - Phone:907-465-2112
Mailing Address - Fax:907-465-2333
Practice Address - Street 1:240 MAIN ST STE 700
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-2107
Practice Address - Country:US
Practice Address - Phone:907-465-2112
Practice Address - Fax:907-465-2333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ALASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management