Healthcare Provider Details

I. General information

NPI: 1881852663
Provider Name (Legal Business Name): MORNING STAR RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2757 COLLEGE RD
FAIRBANKS AK
99709-3751
US

IV. Provider business mailing address

PO BOX 80711
FAIRBANKS AK
99708-0711
US

V. Phone/Fax

Practice location:
  • Phone: 907-455-6772
  • Fax: 907-374-4480
Mailing address:
  • Phone: 907-455-6772
  • Fax: 907-374-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCMG764
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCM7641
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberHC7641
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberHC7641
License Number StateAK
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberHC7641
License Number StateAK
# 7
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateAK

VIII. Authorized Official

Name: MR. BENNIE DAVID COLBERT SR. SR.
Title or Position: PRESIDENT
Credential:
Phone: 907-978-9890