MEDICARE: EYE TO EYE ALH

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	3104A0625X	Assisted Living Facility (Mental Illness)	100162	AK
2	343900000X	Non-emergency Medical Transport (VAN)	100162	AK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851412324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE TO EYE ALH

Provider Business Mailing Address
First Line	:	3705 ARCTIC BLVD ANCHARAGE ALASKA 99503
Second Line	:	7711 ARLENE STREET #B
City	:	ANCHORAGE
State	:	AK
Zip	:	99502
Country	:	US
Telephone Number	:	907-222-2480
Fax Number	:	907-222-4830

Provider Business Practice Location Address
First Line	:	3705 ARCTIC BLVD # 1211
Second Line	:	7711 ARLENE STREET #B
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-5774
Country	:	US
Telephone Number	:	907-222-2480
Fax Number	:	907-222-4830

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARGARET VALERIE WILLIAMS
Credential	:	PCA
Telephone Number	:	907-222-2480

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	01/06/2012

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Directions to “EYE TO EYE ALH ” Practice Location

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