Healthcare Provider Details

I. General information

NPI: 1164697504
Provider Name (Legal Business Name): ONE FAMILY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2008
Last Update Date: 04/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E NORTHERN LIGHTS BLVD STE C
ANCHORAGE AK
99508-4219
US

IV. Provider business mailing address

PO BOX 112381
ANCHORAGE AK
99511-2381
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-3054
  • Fax: 907-349-3056
Mailing address:
  • Phone: 907-349-3054
  • Fax: 907-349-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberONF02030000001
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierONF02030000001
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerSTATE LICENSE FACILTY ID

VIII. Authorized Official

Name: MRS. SHAUNA B TIESZEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-250-1944