Organization Name: | NORTHERN LIGHTHOUSE DAY CENTER |
NPI Number: | 1003035627 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY JO METTLER (ADMINISTRATOR) |
Mailing Address: | 403 E 24th Ave Anchorage |
State: | AK US |
Postal Code: | 995032107 |
Phone Number: | 9073982939 |
Fax Number: | |
NPI Enumeration Date: | 04/24/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | NONE ISSUED BY STATE |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |