Healthcare Provider Details

I. General information

NPI: 1669250577
Provider Name (Legal Business Name): INTEL-CARE ALASKA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOSTON ST STE 103
ANCHORAGE AK
99504-2031
US

IV. Provider business mailing address

1011 BOSTON ST STE 103
ANCHORAGE AK
99504-2031
US

V. Phone/Fax

Practice location:
  • Phone: 907-342-9328
  • Fax:
Mailing address:
  • Phone: 907-342-9328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MATTHEW A TENNANT
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-342-9328