1043216997 NPI number — EASTERSEALS ALASKA

Table of content: (NPI 1043216997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043216997 NPI number — EASTERSEALS ALASKA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERSEALS ALASKA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EASTER SEALS ALASKA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043216997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 W FIREWEED LN STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99503-2561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-277-7325
Provider Business Mailing Address Fax Number:
907-272-7325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 W FIREWEED LN STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99503-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-277-7325
Provider Business Practice Location Address Fax Number:
907-272-7325
Provider Enumeration Date:
06/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUTIERREZ-OSBORNE
Authorized Official First Name:
V
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO / EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
907-277-7325

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  280429 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PCG803 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: HC1831 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".