Healthcare Provider Details

I. General information

NPI: 1316151095
Provider Name (Legal Business Name): ALZHEIMER'S DISEASE RESOURCE AGENCY OF ALASKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 ABBOTT RD
ANCHORAGE AK
99507-3443
US

IV. Provider business mailing address

1750 ABBOTT RD
ANCHORAGE AK
99507-3443
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-3313
  • Fax: 907-561-3315
Mailing address:
  • Phone: 907-561-3313
  • Fax: 907-561-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L IVORY
Title or Position: CARE COORDINATION DIRECTOR
Credential:
Phone: 907-864-3415