Healthcare Provider Details

I. General information

NPI: 1699216606
Provider Name (Legal Business Name): ENRICHMENT CENTER FOR MATURE ADULTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 E TUDOR RD STE 33
ANCHORAGE AK
99507-1069
US

IV. Provider business mailing address

2207 E TUDOR RD STE 33
ANCHORAGE AK
99507-1069
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-1083
  • Fax: 907-561-1075
Mailing address:
  • Phone: 907-561-1083
  • Fax: 907-561-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TOU XIONG
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 907-561-1083