Healthcare Provider Details

I. General information

NPI: 1346886660
Provider Name (Legal Business Name): SET FREE ALASKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E BOGARD RD BLDG 2
WASILLA AK
99654-4711
US

IV. Provider business mailing address

PO BOX 876741
WASILLA AK
99687-6741
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-4732
  • Fax:
Mailing address:
  • Phone: 907-373-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MEGAN LINDLEY
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 907-206-6055