Provider Demographics
NPI:1861522773
Name:BJORGE HOUSE ENTERPRISES
Entity type:Organization
Organization Name:BJORGE HOUSE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BJORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-874-4166
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:127 CHURCH STREET
Mailing Address - City:WRANGELL
Mailing Address - State:AK
Mailing Address - Zip Code:99929-1051
Mailing Address - Country:US
Mailing Address - Phone:907-874-4166
Mailing Address - Fax:907-874-4166
Practice Address - Street 1:127 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:WRANGELL
Practice Address - State:AK
Practice Address - Zip Code:99929-1051
Practice Address - Country:US
Practice Address - Phone:907-874-4166
Practice Address - Fax:907-874-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKRL7770320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL7770Medicaid