Healthcare Provider Details

I. General information

NPI: 1477047579
Provider Name (Legal Business Name): ANCORA HOME HEALTH & HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 E BLUE LUPINE DR STE B
WASILLA AK
99654-8461
US

IV. Provider business mailing address

258 S MAIN ST STE 210
LOGAN UT
84321-5768
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-9240
  • Fax: 866-934-0349
Mailing address:
  • Phone: 907-561-9240
  • Fax: 866-934-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
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: GREGORY CHAD MANGUM
Title or Position: CEO
Credential: RN
Phone: 907-561-0700