Provider Demographics
NPI:1043216997
Name:EASTERSEALS ALASKA
Entity Type:Organization
Organization Name:EASTERSEALS ALASKA
Other - Org Name:EASTER SEALS ALASKA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO / EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:V
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ-OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-277-7325
Mailing Address - Street 1:670 W FIREWEED LN STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2561
Mailing Address - Country:US
Mailing Address - Phone:907-277-7325
Mailing Address - Fax:907-272-7325
Practice Address - Street 1:670 W FIREWEED LN STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2561
Practice Address - Country:US
Practice Address - Phone:907-277-7325
Practice Address - Fax:907-272-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK280429251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG803Medicaid
AKHC1831Medicaid