Healthcare Provider Details

I. General information

NPI: 1982514436
Provider Name (Legal Business Name): MOSES JOHN DANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E 13TH AVE
ANCHORAGE AK
99501-4549
US

IV. Provider business mailing address

2421 FOXHALL DR
ANCHORAGE AK
99504-3341
US

V. Phone/Fax

Practice location:
  • Phone: 907-240-7100
  • Fax: 907-868-7501
Mailing address:
  • Phone: 907-240-7100
  • Fax: 907-868-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number102111
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: