Provider Demographics
NPI:1841652393
Name:SWANBERG HUMAN SERVICES, LLC
Entity type:Organization
Organization Name:SWANBERG HUMAN SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JULIANA
Authorized Official - Last Name:SWANBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:907-512-0601
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-0785
Mailing Address - Country:US
Mailing Address - Phone:907-512-0601
Mailing Address - Fax:907-512-0602
Practice Address - Street 1:326 CENTER AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7302
Practice Address - Country:US
Practice Address - Phone:907-512-0601
Practice Address - Fax:907-512-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCM# 1600651251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management