Provider Demographics
NPI:1538982095
Name:MAT SU YOUTH HOUSING-MY HOUSE
Entity type:Organization
Organization Name:MAT SU YOUTH HOUSING-MY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-373-4357
Mailing Address - Street 1:300 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7042
Mailing Address - Country:US
Mailing Address - Phone:907-373-4357
Mailing Address - Fax:
Practice Address - Street 1:871 E OLD MATANUSKA RD.
Practice Address - Street 2:UNIT 1
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility