Healthcare Provider Details

I. General information

NPI: 1326758103
Provider Name (Legal Business Name): IT WORKS CADAVOS FOSTER HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/04/2022
Certification Date: 12/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 LEAWOOD DR
ANCHORAGE AK
99502-1618
US

IV. Provider business mailing address

2955 LEAWOOD DR
ANCHORAGE AK
99502-1618
US

V. Phone/Fax

Practice location:
  • Phone: 907-339-8015
  • Fax: 907-308-6856
Mailing address:
  • Phone: 907-339-8015
  • Fax: 907-308-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MARIALIZA NARANJO CADAVOS
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 907-339-8015