Healthcare Provider Details

I. General information

NPI: 1245448265
Provider Name (Legal Business Name): CONSUMER CARE NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W BENSON BLVD SUITE 101
ANCHORAGE AK
99503-3860
US

IV. Provider business mailing address

PO BOX 111761
ANCHORAGE AK
99511-1761
US

V. Phone/Fax

Practice location:
  • Phone: 907-529-1572
  • Fax:
Mailing address:
  • Phone: 907-334-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number433132
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number433132
License Number StateAK

VIII. Authorized Official

Name: OGBOUMA OKE ULOFOSHIO
Title or Position: PRESIDENT
Credential:
Phone: 907-529-1572