Provider Demographics
NPI:1134512304
Name:CONFIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:CONFIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PSYCHIATRIC NURSE PRACTITIO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUCHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-PMHNP
Authorized Official - Phone:907-357-1999
Mailing Address - Street 1:2341 S. FERN ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8589
Mailing Address - Country:US
Mailing Address - Phone:907-357-1999
Mailing Address - Fax:907-357-1990
Practice Address - Street 1:2341 S. FERN ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8589
Practice Address - Country:US
Practice Address - Phone:907-357-1999
Practice Address - Fax:907-357-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YP2500X, 1041C0700X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK=========OtherEIN