Organization
MAT SU YOUTH HOUSING
Active
Other names
My House
Organization subpart
No
Provider details
NPI number
Authorized official
KYRA MACKEY AAS, CDC 1, PSP III (ADMINISTRATIVE MANAGER)
(907) 830-0506
Entity
Organization
Contact information
Practice address
300 N WILLOW ST, WASILLA, AK 99654-7042
(907) 373-4358
Mailing address
300 N WILLOW ST, WASILLA, AK 99654-7042
(907) 373-4358
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1745121
—
AK
05
—
1761139
—
AK
Enumeration date
02/13/2024
Last updated
04/30/2026
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