=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700137916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPEN PERSONAL CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2012
-----------------------------------------------------
Last Update Date | 09/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 ATHABASKAN DRIVE
-----------------------------------------------------
City | SOLDOTNA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99669-1170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-398-8156
-----------------------------------------------------
Fax | 907-260-3773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1000
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99672-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-398-8156
-----------------------------------------------------
Fax | 907-260-3773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. LESTER E JACQUES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 907-398-8156
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 970900
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------