MEDICARE: MVCMH-KEVIN'S HOUSE

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
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1053266346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVCMH-KEVIN'S HOUSE

Provider Business Mailing Address
First Line	:	6830 E 12TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1832
Country	:	US
Telephone Number	:	907-222-4851
Fax Number	:	907-885-6535

Provider Business Practice Location Address
First Line	:	6830 E 12TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1832
Country	:	US
Telephone Number	:	907-222-4851
Fax Number	:	907-885-6535

Authorized Official
Title or Position	:	OWNER
Name	:	DELPHINE ANGHA ATU-TETUH
Credential	:
Telephone Number	:	907-222-4851

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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