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General NPI Number Information
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NPI Number | 1952524779
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Entity Type | Organization
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Legal Business Name | RESPECT YOUR ELDERS
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 2301 COLLEEN ST
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City | PALMER
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State | AK
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Zip | 99645
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Country | US
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Telephone | 907-745-3687
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Fax | 907-746-3687
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Provider Business Mailing Address
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Address Line | PO BOX 2422
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City | PALMER
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State | AK
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Zip | 99645
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Country | US
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Telephone | 907-745-3687
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Fax | 907-746-3687
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. JOHNNIE DAVIS
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Credential |
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Telephone | 907-775-0345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 230512
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License Number State | AK
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