Healthcare Provider Details

I. General information

NPI: 1902934300
Provider Name (Legal Business Name): IMMEDIATE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 DEBARR ROAD
ANCHORAGE AK
99504
UM

IV. Provider business mailing address

PO BOX 103913
ANCHORAGE AK
99510-3913
US

V. Phone/Fax

Practice location:
  • Phone: 907-336-3365
  • Fax: 907-929-5661
Mailing address:
  • Phone: 907-336-3365
  • Fax: 907-929-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number714562
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number714562
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number714562
License Number StateAK

VIII. Authorized Official

Name: MIRASOL MIRASOL ISLA
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 907-336-3365