Organization
MORNING STAR RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENNIE DAVID COLBERT SR. SR. (PRESIDENT)
(907) 978-9890
Entity
Organization
Contact information
Practice address
2757 COLLEGE RD, FAIRBANKS, AK 99709-3751
(907) 455-6772
(907) 374-4480
Mailing address
PO BOX 80711, FAIRBANKS, AK 99708-0711
(907) 455-6772
(907) 374-4480
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
CM7641
AK
251B00000X
Case Management Agency
CMG764
AK
251C00000X
Developmentally Disabled Services Day Training Agency
HC7641
AK
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
AK
347C00000X
Private Vehicle
HC7641
AK
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
HC7641
AK
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004993
—
AK
05
—
HC7641
—
AK
Enumeration date
05/28/2008
Last updated
07/28/2014
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