Provider Demographics
NPI:1063663912
Name:EASTER SEALS ALASKA
Entity Type:Organization
Organization Name:EASTER SEALS ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
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 1:301 CUSHMAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4629
Mailing Address - Country:US
Mailing Address - Phone:907-452-5126
Mailing Address - Fax:907-452-5157
Practice Address - Street 1:301 CUSHMAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4629
Practice Address - Country:US
Practice Address - Phone:907-452-5126
Practice Address - Fax:907-452-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK280429251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management