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NPI Code Detail

MEDICARE: EASTERSEALS ALASKA

MEDICARE: EASTERSEALS ALASKA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency280429AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043216997
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERSEALS ALASKA
Provider Business Mailing Address
First Line : 670 W FIREWEED LN STE 201
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-2561
Country : US
Telephone Number : 907-277-7325
Fax Number : 907-272-7325
Provider Business Practice Location Address
First Line : 670 W FIREWEED LN STE 201
Second Line :
City : ANCHORAGE
State : AK
Zip : 99503-2561
Country : US
Telephone Number : 907-277-7325
Fax Number : 907-272-7325
Authorized Official
Title or Position : CEO / EXECUTIVE DIRECTOR
Name : V GUTIERREZ-OSBORNE
Credential :
Telephone Number : 907-277-7325
Provider Enumeration Date : 06/24/2005
Last Update Date : 07/30/2020

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1700020211 — MR. SIDNEY LEE COWAN RN
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1265741565 — MISS JONA MARIE PEASE RN
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Directions to “EASTERSEALS ALASKA ” Practice Location

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