Healthcare Provider Details

I. General information

NPI: 1619156254
Provider Name (Legal Business Name): ELDER OPTIONS OF ALASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60788 BEAR CREEK DR
HOMER AK
99603-9461
US

IV. Provider business mailing address

60788 BEAR CREEK DR
HOMER AK
99603-9461
US

V. Phone/Fax

Practice location:
  • Phone: 907-299-0352
  • Fax: 907-235-4093
Mailing address:
  • Phone: 907-299-0352
  • Fax: 907-235-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberHC1641
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHC1641
License Number StateAK

VIII. Authorized Official

Name: PAMELA S HORAZDOVSKY
Title or Position: OWNER/ADMINSTRATOR
Credential: BSW, MAG
Phone: 907-299-0352