Provider Demographics
NPI:1972978492
Name:DOUGLAS ISLAND GIRL LLC
Entity type:Organization
Organization Name:DOUGLAS ISLAND GIRL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-364-2395
Mailing Address - Street 1:2190 LAWSON CREEK RD APT B
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-5028
Mailing Address - Country:US
Mailing Address - Phone:907-364-2395
Mailing Address - Fax:
Practice Address - Street 1:2190 LAWSON CREEK RD APT B
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AK
Practice Address - Zip Code:99824-5028
Practice Address - Country:US
Practice Address - Phone:907-364-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1023230251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management