Provider Demographics
NPI:1730720459
Name:FORGET-ME-NOTWELLNESS SERVICES
Entity type:Organization
Organization Name:FORGET-ME-NOTWELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPN/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN/COUNSELOR
Authorized Official - Phone:907-891-1878
Mailing Address - Street 1:401 E NORTHERN LIGHTS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2814
Mailing Address - Country:US
Mailing Address - Phone:907-891-1878
Mailing Address - Fax:
Practice Address - Street 1:401 E NORTHERN LIGHTS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2814
Practice Address - Country:US
Practice Address - Phone:907-891-1878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1578111423Medicaid
AK84-191380Medicaid