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General NPI Number Information
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NPI Number | 1295170348
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Entity Type | Organization
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Legal Business Name | POLARIS HOUSE INC.
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 434 WILLOUGHBY AVE
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City | JUNEAU
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State | AK
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Zip | 99801-1724
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Country | US
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Telephone | 907-780-6775
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Fax | 907-780-6774
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Provider Business Mailing Address
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Address Line | PO BOX 21661
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City | JUNEAU
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State | AK
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Zip | 99802-1661
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Country | US
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Telephone | 907-780-6775
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Fax | 907-780-6774
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DOROTHY LUCILLE GREEN
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Credential |
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Telephone | 907-780-6775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 914750
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License Number State | AK
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