MEDICARE: ENRICHMENT CENTER FOR MATURE ADULTS, LLC

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	343900000X	Non-emergency Medical Transport (VAN)
2	261QA0600X	Adult Day Care Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1699216606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICHMENT CENTER FOR MATURE ADULTS, LLC

Provider Business Mailing Address
First Line	:	2207 E TUDOR RD STE 33
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1069
Country	:	US
Telephone Number	:	907-561-1083
Fax Number	:	907-561-1075

Provider Business Practice Location Address
First Line	:	2207 E TUDOR RD STE 33
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1069
Country	:	US
Telephone Number	:	907-561-1083
Fax Number	:	907-561-1075

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	TOU XIONG
Credential	:
Telephone Number	:	907-561-1083

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/10/2017

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