MEDICARE: LILYANN'S HOME CARE INC.

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	:	1629562897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILYANN'S HOME CARE INC.

Provider Business Mailing Address
First Line	:	935 NORMAN ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1617
Country	:	US
Telephone Number	:	907-646-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	935 NORMAN ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1617
Country	:	US
Telephone Number	:	907-646-0702
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIRECTOR
Name	:	CAROL DISIALVI
Credential	:
Telephone Number	:	907-646-0702

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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