Healthcare Provider Details

I. General information

NPI: 1669930186
Provider Name (Legal Business Name): MARCELLA ADRIENNE FOISY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 E RILEY ALEXANDER CIR
PALMER AK
99645-7725
US

IV. Provider business mailing address

7310 E RILEY ALEXANDER CIR
PALMER AK
99645-7725
US

V. Phone/Fax

Practice location:
  • Phone: 907-521-0888
  • Fax: 907-357-8547
Mailing address:
  • Phone: 907-521-0888
  • Fax: 907-357-8547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number101241
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: