Provider Demographics
NPI:1043432289
Name:GREENWOOD LODGE ADULT DAY AND RESPITE CARE SERVICES INC.
Entity Type:Organization
Organization Name:GREENWOOD LODGE ADULT DAY AND RESPITE CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIETA
Authorized Official - Middle Name:AGUILAR
Authorized Official - Last Name:ORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-868-5297
Mailing Address - Street 1:2351 COPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1956
Mailing Address - Country:US
Mailing Address - Phone:907-868-5297
Mailing Address - Fax:907-868-5185
Practice Address - Street 1:2351 COPPERWOOD DR
Practice Address - Street 2:8100 GREENWOOD ST.
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1956
Practice Address - Country:US
Practice Address - Phone:907-868-5297
Practice Address - Fax:907-868-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC6770Medicaid