MEDICARE: FLAMINGO HOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)
2	343900000X	Non-emergency Medical Transport (VAN)	100377	AK
3	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	100377	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457474561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAMINGO HOUSE

Provider Business Mailing Address
First Line	:	3705 ARCTIC BLVD ANCHORAGE ALASKA 99503
Second Line	:	8611 FLAMINGO DRIVE
City	:	ANCHORAGE
State	:	AK
Zip	:	99502
Country	:	US
Telephone Number	:	907-222-1675
Fax Number	:	907-222-4830

Provider Business Practice Location Address
First Line	:	3705 ARCTIC BLVD # 1211
Second Line	:	7711 ARLENE STREET #A
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5774
Country	:	US
Telephone Number	:	907-222-6899
Fax Number	:	907-222-6899

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARGARET VALERIE WILLIAMS
Credential	:	PCA
Telephone Number	:	907-222-6899

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	03/27/2009

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Directions to “FLAMINGO HOUSE ” Practice Location

Language	Start Address	Practice Location

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