MEDICARE: MR. RONARDO ADOLPHUS COLEMAN

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	385H00000X	Respite Care	2115310	AK

General Provider Information

NPI Number	:	1932779188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONARDO ADOLPHUS COLEMAN

Provider Business Mailing Address
First Line	:	PO BOX 211526
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99521-1526
Country	:	US
Telephone Number	:	907-952-4651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 CRESCENT DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5010
Country	:	US
Telephone Number	:	907-952-4651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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