Provider Demographics
NPI:1063071660
Name:LINKS MAT-SU PARENT RESOURCE CENTER
Entity type:Organization
Organization Name:LINKS MAT-SU PARENT RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:COATES
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:907-373-3631
Mailing Address - Street 1:777 N CRUSEY ST STE A101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7100
Mailing Address - Country:US
Mailing Address - Phone:907-373-3632
Mailing Address - Fax:907-373-3620
Practice Address - Street 1:777 N CRUSEY ST STE A101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7100
Practice Address - Country:US
Practice Address - Phone:907-373-3632
Practice Address - Fax:907-373-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty