Provider Demographics
NPI:1114220233
Name:YOSEF FAMILY HOME
Entity Type:Organization
Organization Name:YOSEF FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-720-9319
Mailing Address - Street 1:6851 TAMIR AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3954
Mailing Address - Country:US
Mailing Address - Phone:907-720-9319
Mailing Address - Fax:907-868-8034
Practice Address - Street 1:922 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2229
Practice Address - Country:US
Practice Address - Phone:907-720-9319
Practice Address - Fax:907-868-8034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100843253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCOS 84Medicaid