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NPI Code Detail

MEDICARE: MAT SU YOUTH HOUSING

MEDICARE: MAT SU YOUTH HOUSING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417711011
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAT SU YOUTH HOUSING
Provider Business Mailing Address
First Line : 300 N WILLOW ST
Second Line :
City : WASILLA
State : AK
Zip : 99654-7042
Country : US
Telephone Number : 907-373-4358
Fax Number :
Provider Business Practice Location Address
First Line : 300 N WILLOW ST
Second Line :
City : WASILLA
State : AK
Zip : 99654-7042
Country : US
Telephone Number : 907-373-4358
Fax Number :
Authorized Official
Title or Position : ADMINISTRATIVE MANAGER
Name : KYRA MACKEY
Credential : AAS, CDC 1, PSP III
Telephone Number : 907-830-0506
Provider Enumeration Date : 02/13/2024
Last Update Date : 04/30/2026

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1851237812 — ABDULRAHMAN BEN-SALAMAH
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1265086078 — BRYAN FIELDS
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Directions to “MAT SU YOUTH HOUSING ” Practice Location

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