=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720269046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 11/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 E BOGARD RD
-----------------------------------------------------
City | WASILLA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99654-6014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-376-5483
-----------------------------------------------------
Fax | 907-376-5423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189 E. NELSON #123
-----------------------------------------------------
City | WASILLA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-376-2697
-----------------------------------------------------
Fax | 907-376-7966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SEC/TREA
-----------------------------------------------------
Name | BERKLEY H TILTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 907-376-2697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 100604
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------