Provider Demographics
NPI:1881852663
Name:MORNING STAR RANCH
Entity type:Organization
Organization Name:MORNING STAR RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COLBERT SR.
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:907-978-9890
Mailing Address - Street 1:PO BOX 80711
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0711
Mailing Address - Country:US
Mailing Address - Phone:907-455-6772
Mailing Address - Fax:907-374-4480
Practice Address - Street 1:2757 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3751
Practice Address - Country:US
Practice Address - Phone:907-455-6772
Practice Address - Fax:907-374-4480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKHC7641251C00000X, 347C00000X, 385HR2060X
AKCMG764251B00000X
AKCM7641251B00000X
AK385HR2060X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC7641Medicaid
AK1004993Medicaid