Healthcare Provider Details

I. General information

NPI: 1619110004
Provider Name (Legal Business Name): MY DAUGHTER AND ME ALH, II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 ROOSEVELT DR
ANCHORAGE AK
99517-3040
US

IV. Provider business mailing address

2202 ROOSEVELT DR
ANCHORAGE AK
99517-3040
US

V. Phone/Fax

Practice location:
  • Phone: 907-677-7767
  • Fax: 907-677-7767
Mailing address:
  • Phone: 907-677-7767
  • Fax: 907-677-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number923799
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number923799
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number923799
License Number StateAK

VIII. Authorized Official

Name: MS. MARY LOUISE LUNDY
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 907-830-3055