Healthcare Provider Details

I. General information

NPI: 1043432289
Provider Name (Legal Business Name): GREENWOOD LODGE ADULT DAY AND RESPITE CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 COPPERWOOD DR 8100 GREENWOOD ST.
ANCHORAGE AK
99516-1956
US

IV. Provider business mailing address

2351 COPPERWOOD DR
ANCHORAGE AK
99516-1956
US

V. Phone/Fax

Practice location:
  • Phone: 907-868-5297
  • Fax: 907-868-5185
Mailing address:
  • Phone: 907-868-5297
  • Fax: 907-868-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS JULIETA AGUILAR ORRES
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 907-868-5297