Healthcare Provider Details

I. General information

NPI: 1679038376
Provider Name (Legal Business Name): FAR NORTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 E HEATHER WAY
WASILLA AK
99654-1410
US

IV. Provider business mailing address

PO BOX 879390
WASILLA AK
99687-9390
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-0055
  • Fax:
Mailing address:
  • Phone: 907-414-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MERI KAY TEICH
Title or Position: OWNER
Credential: RN
Phone: 907-414-8665